IDEXX LaserCyte TM. 2 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential LaserCyte Training...

IDEXX LaserCyteTM

2 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential

LaserCyte Training

LaserCyte™ Parameters

LaserCyte Parameters Medical ReasonsThe “What” and “So What” Summary


LaserCyte Training

LaserCyte™ Parameters

White blood Cell

Red blood Cells

Platlets


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Red Blood Cells

• Is there evidence of anemia? Regenerative or nonregenerative with Regenerative or nonregenerative with

reticulocyte countreticulocyte count

• Is there evidence of dehydration? PolycythemiaPolycythemia


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Red Blood Cells

HCT (Hematocrit) Percentage of the red cell population relative Percentage of the red cell population relative

to the total volume of bloodto the total volume of blood

It is a calculation by the LaserCyteIt is a calculation by the LaserCyte

40 – 59% dogs; 29 – 50% cats40 – 59% dogs; 29 – 50% cats

Used to diagnose anemia or polycythemiaUsed to diagnose anemia or polycythemia

RBC (Red Blood Cell Count) AActual number of RBCs in a given quantity of ctual number of RBCs in a given quantity of

bloodblood Average is 5.9 - 8.6 X 10Average is 5.9 - 8.6 X 1066 μL for dogs or 5 -μL for dogs or 5 -

10 10 X 10X 1066 μL for catsμL for cats


LaserCyte Training

Red Blood Cells

HGB (Hemoglobin) A measurement of the oxygen carrying capacity of the A measurement of the oxygen carrying capacity of the

red blood cellsred blood cells

The LaserCyte uses four LEDs and photodetectors that The LaserCyte uses four LEDs and photodetectors that

measure Hgb concentration by at least three different measure Hgb concentration by at least three different

wavelengths of light and two different aspirates, unlysed wavelengths of light and two different aspirates, unlysed

and lysed.and lysed.


LaserCyte Training

Red Blood Cells

# Retics The number of reticulocytes is a definitive indicator to The number of reticulocytes is a definitive indicator to

distinguish between regenerative and non-regenerative distinguish between regenerative and non-regenerative

anemias. anemias.

The LaserCyte gives aggregate retics in the catThe LaserCyte gives aggregate retics in the cat

A retic count above 60,000 A retic count above 60,000 μL in cats and 80,000 μL in μL in cats and 80,000 μL in

dogs in considered a regenerative anemiadogs in considered a regenerative anemia % Retics

Percentage of reticulocytes in a given quantity of bloodPercentage of reticulocytes in a given quantity of blood

Average is 0.0 – 1.5% Average is 0.0 – 1.5% for dogs or 0.0 – 0.4% for catsfor dogs or 0.0 – 0.4% for cats

A retic count offers a quick and easy assessment of an anemia

state. A count, unlike a percentage is not affected by

dehydration.


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Red Blood Cells

MCV (Mean Corpuscular Volume) The mean volume of all the RBCs counted in the sample The mean volume of all the RBCs counted in the sample

Smaller than normal is microcytic larger is macrocyticSmaller than normal is microcytic larger is macrocytic

Used to indicate spherocytes, anisocytosis, or schistocytes Used to indicate spherocytes, anisocytosis, or schistocytes

all of which must be confirmed with a morphology examall of which must be confirmed with a morphology exam RDW (Red Cell Distribution Width)

Measurement of the variation of size with in the RBC Measurement of the variation of size with in the RBC

population. Given as a percentagepopulation. Given as a percentage

Used to indicate anisocytosis, also used by impedance Used to indicate anisocytosis, also used by impedance

analyzer users to indicate the presence of retics with MCVanalyzer users to indicate the presence of retics with MCV


LaserCyte Training

Red Blood Cells

MCHC (Mean Corpuscular Hemoglobin Conc)

The mean concentration of hemoglobin in the red cellThe mean concentration of hemoglobin in the red cell

Calculated by dividing the hemoglobin by the Calculated by dividing the hemoglobin by the

hematocrit and expressing the answer as a percentagehematocrit and expressing the answer as a percentage

Important in classifying anemiasImportant in classifying anemias

Normal ranges are 30.0 – 36.9%Normal ranges are 30.0 – 36.9% MCH (Mean Corpuscular Hemoglobin)

Mean mass of hemoglobin in each RBCMean mass of hemoglobin in each RBC

Calculated by dividing the hemoglobin by the number Calculated by dividing the hemoglobin by the number

of RBCsof RBCs


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White blood cell data answers

• Is there evidence of inflammation? Acute, chronic or overwhelmingAcute, chronic or overwhelming

• Is there evidence of stress or excitement?

High levels of glucocorticoids cause mild High levels of glucocorticoids cause mild

neutrophilia, lymphopenia and eosinophilianeutrophilia, lymphopenia and eosinophilia

• Is there a demand for phagocytosis or evidence of tissue necrosis?

Elevated monocytosis is almost always seen Elevated monocytosis is almost always seen

in chronic inflammationin chronic inflammation


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White Blood Cells

WBC (White Blood Cell Count) Total count of all White blood cellsTotal count of all White blood cells Reported as X 10Reported as X 1033 μL μL

Indicator of infection (not diagnostic alone)Indicator of infection (not diagnostic alone)


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White Blood Cells

Lymphocytes White blood cell that produces antibodiesWhite blood cell that produces antibodies

20 – 30% of WBC population20 – 30% of WBC population

Lymphocytosis: Prolonged illness, chronic Lymphocytosis: Prolonged illness, chronic

inflammation,inflammation,

Lymphopenia: Acute inflammation, viral infection, Lymphopenia: Acute inflammation, viral infection,

stress, steroid therapystress, steroid therapyMonocytes

Reported as X 10Reported as X 1033 μL μL

Indicator of infection (not diagnostic alone)Indicator of infection (not diagnostic alone)


LaserCyte Training

White Blood Cells

Neutrophils Most common leukocyteMost common leukocyte

Two classifications: Banded and SegmentedTwo classifications: Banded and Segmented

Engulf disease causing bacteria, viruses, and Engulf disease causing bacteria, viruses, and

particles (phagocytosis)particles (phagocytosis) Eosinophils

Involved in allergies and parasitic infectionInvolved in allergies and parasitic infection

Usually only in circulation for about 30 minUsually only in circulation for about 30 min .1 – 1.5 X 10.1 – 1.5 X 1033 μL normal rangeμL normal range


LaserCyte Training

White Blood Cells

Basophils Having the basophil # and % aids in identifyingHaving the basophil # and % aids in identifying

• Systemic hypersensitivitySystemic hypersensitivity

• Acute allergic reactionsAcute allergic reactions

• Mast cell sarcomasMast cell sarcomas


LaserCyte Training

The Medical Reasons

White Blood Cells

Decreased/

no change

Increased

Variable

Variable

EOS

Increased

Decreased/ no

change

Increased/ no

change

Increased

NEUTS

Increased

Increased/

Variable

Increased/ no

change

Increased

WBC

Stress

Leukogram

Parasites

Chronic

Inflammation

Acute

Inflammation

MONOSLYMPHS

Increased/

no change

Decreased

Increased/

no change

Variable

IncreasedIncreased/

no change

variableDecreased


LaserCyte Training

Is it a stress leukogram or inflammation?

NormalLowEosinophils

Slightly highSlightly highMonocytes

NormalLowLymphocytes

HighHighNeutrophils

HighHighWBC Count

InflammationStressParameters


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3-part versus 5-part differential

YesNo Steroid therapy

YesNo Excitement

YesNo Stress

YesNo Infection

YesNo Inflammation

5-part3-partElevated neutrophils

YesNo Overwhelming infection

YesNo Erhlichiosis

YesNo Parvo

Decreased neutrophils

YesNo FIV


LaserCyte Training

3-part versus 5-part differential

YesNoAddison’s disease

YesNoHeartworm

YesNoMast cell tumors

YesNoAllergies

YesNoParasites

5-part3-partElevated basophils

and eosinophils

YesNoParvo

YesNoStress

YesNoDistemper

YesNoCushing’s syndrome


LaserCyte Training

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 clottingInvolved in clotting

• PLT is a platelet countPLT is a platelet count

• Thrombocytopenia can be seen in Ehrlichia, FIV, FELVThrombocytopenia can be seen in Ehrlichia, FIV, FELV

• MPV• MPV (mean platelet volume) aids in the identification of MPV (mean platelet volume) aids in the identification of

what may be causing a severe thrombocytopeniawhat may be causing a severe thrombocytopenia

• PDW• PDW (platelet distribution width) is an objective PDW (platelet distribution width) is an objective

measure of the degree of variability in the size of measure of the degree of variability in the size of

platelets and can indicate bone marrow responseplatelets and can indicate bone marrow response

**Absolute count—Available using the LaserCyte analyzer.


LaserCyte Training

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 To prevent cell distortions due to

shipment or storageshipment or storage

To prevent artifacts created by long-term To prevent artifacts created by long-term

exposure to EDTAexposure to EDTA


LaserCyte Training

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; 2002:11.


LaserCyte Training

Which system is ideally suited for your needs?

YesYes---YesRDW

YesYesYesYesMCHC

YesYes---YesMCV

---Request% onlyYesReticulocytes

YesYesYesYesHgb

YesYesYesYesPCV/Hct

YesYes---YesRBC Count

ImpedenceLabQBC

VetAutoread™LaserCyte


LaserCyte Training


---Yes, absolute count and %---Yes, absolute

count and %Neutrophils

Middle-sized cells number

and %Yes, absolute count and %

Grouped with lymphocytes

Yes, absolute count and %Monocytes

Small-sized cells number

and %

Yes, absolute count and %

Grouped with monocytes

Yes, absolute count and %Lymphocytes

nRBCs misclassified

Yes, corrected for nRBC

Not corrected for nRBC

Yes, corrected for nRBCWBC Count

ImpedenceLabQBC



LaserCyte Training


YesYes---Yes, absolute countPDW

YesYes---Yes, absolute countMPV

---Yes, bsolute count and %YesYes, absolute

count and %Basophils

---Yes, bsolute count and %

Elevated canine and bovine

Yes, absolute count and %Eosinophils

Yes, size only, clumps may go uncounted or misidentified as WBCs

Not always, usually reports broad categories (i.e., adequate)

Yes, good correlation with clumped platelet samples

Yes, optical signature,clumps do not interfere with WBC count

Platelet Count

ImpedenceLabQBC



LaserCyte Training

The Doctor’s 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. The QBC Vet AutoRead is and was a good in-clinic system.

However, as with anything the advances in technology now make However, as with anything the advances in technology now make

it affordable and possible to practice the best medicine available it affordable and possible to practice the best medicine available

right in your clinic. …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.


LaserCyte Training

The Doctor’s 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. As discussed, a CBC is a time sensitive test.

Platelets clump, red cells change shape and size, Platelets clump, red cells change shape and size,

bands change to segs, lymphocytes, neutrophils, bands change to segs, lymphocytes, neutrophils,

and eosinophils can change size, etc.and eosinophils can change size, etc. This immediate information is critical in many This immediate information is critical in many

cases.cases. Not only does the cells change, the animals Not only does the cells change, the animals

condition changes between draw and results from condition changes between draw and results from

the labthe lab


LaserCyte Training

The Doctor’s view

“Other in-clinic analyzer’s are just as good, and cost about $5k to $8k less”

Laser Flow Cytometry is the standard in Laser Flow Cytometry is the standard in automated hematology.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.


LaserCyte Training

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


LaserCyte Training

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.


LaserCyte Training

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.

IDEXX LaserCyte TM. 2 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential LaserCyte Training...

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Transcript of IDEXX LaserCyte TM. 2 © 2002 IDEXX LABORATORIES, INC. | IDEXX Confidential LaserCyte Training...