Blood Glucose (bg) or Blood Sugar (bs) The concentration of glucose in the blood. Measured in milligrams per deciliter (mg/dL) in the US, and millimoles per liter (mmoles/L) in metric. Note: different countries use different units of measurement. This is important to remember if you are talking with someone from Canada who is using the metric system. The conversion factor is approximately 18. Divide the US value by 18 to get the metric value. Examples: In the US, a bg of 100 mg/dL is about the same as 5.6 mmol/L. In Canada, a metric bg of 22 mmoles/L is equivalent to a US bg of about 396. Make sure you know what units you are dealing with. Here's a handy reference chart
Blood glucose curve (serial blood glucose determination) When the blood glucose is measured several times over a period of several hours. A typical blood glucose curve would involve taking bg tests every 1 or 2 hours for 12 hours. Sometimes a 24 hour long curve is done. The amount of time between each test can also vary. A blood glucose curve helps determine the onset, peak, and duration of action of the insulin.
DC Diabetic cat
DD Diabetic dog
Diabetes A disorder of glucose metabolism where there is not enough insulin to regulate blood sugar levels. Or, where insulin is present, but the cells do not respond to it properly.
DX diagnosed, diagnosis
Endogenous Produced inside the body. Insulin produced by the pancreas is endogenous insulin.
Exogenous Supplied to the body from an external source. Insulin injected into the body is exogenous insulin.
Glucagon A hormone secreted by the alpha cells of the pancreas. Glucagon is responsible for raising blood glucose.
Glucose A molecule (single unit) of sugar. Glucose is one of the main sugars used by the body's cells for energy.
Glucosuria Glucose in the urine
"Honeymoon" A period where the diabetic enters a phase of either reduced insulin requirement, or requires no exogenous insulin. The "honeymoon" happens relatively soon after diagnosis (weeks to months) and is temporary. It may be related to irregular functioning of beta cells. "Honeymoon" occurs in dogs, cats, and humans. The term "honeymoon" is often used interchangeably with "transient diabetes" - but they have different meanings.
Hormone A substance produced by one part of the body that travels throughout the body and controls functions of other cells. Both insulin and glucagon are hormones: they are produced by the pancreas and travel through the body and control glucose metabolism in other cells.
Hyperglycemia Elevated blood sugar (hyper = high)
Hypoglycemia Low blood sugar (hypo = low)
Insulin A hormone secreted by the beta cells of the pancreas. Insulin is necessary for glucose to enter cells. Insulin is responsible for lowering blood glucose.
Insulin abbreviations
R regular (fast acting) N NPH [a big long name] (intermediate acting) L lente (intermediate acting) U ultralente (long acting) not to be confused with U as in Units of insulin
I.V. Intravenous
Ketoacidosis (Diabetic ketoacidosis) A serious medical condition resulting from uncontrolled diabetes. Ketoacidosis occurs when the body uses fat as an energy source and ketones build up in the blood. Ketoacidosis starts slowly and builds up. Ketoacidosis is a medical emergency and requires immediate medical treatment.
Ketone Waste product produced when the body is using fat as an energy source. Ketones are acids, and can cause damage or death to cells. Excess ketones accumulate in the blood and are excreted in the urine. Acetone is a ketone which can be eliminated through the lungs. Ketoacidotic animals often have a chemical smell to their breath (Some nail polish removers contain acetone - it is a similar smell).
Ketonuria Ketones in the urine. Occurs when the diabetes is uncontrolled and the body is producing ketones.
Metabolism The chemical processes in cells that are involved in using energy and building substances the cells needs. Glucose metabolism relates to how cells use or store glucose. Anabolism refers to the building up processes, catabolism refers to the breaking down processes.
Nadir The lowest point. Refers to the lowest blood glucose concentration on a bg curve.
Polydipsia (PD) Excessive thirst or drinking
Polyphagia Excessive hunger or eating
Polyuria (PU) Excessive urination
Postprandial A few hours after eating
PZI Protamine Zinc Insulin
Q.D. Once a day. From latin: quaque die. Same as s.i.d. but not to be confused with q.i.d.
Q.I.D. Four times a day. From latin: quater in die
RX Prescription
S.I.D. Once a day. From latin semel in die
SubQ. Subcutaneous. Given beneath the skin.
T.I.D Three times a day from latin: ter in die
Transient diabetes A period where the animal does not require exogenous insulin. This period can last weeks, months, or years. Transient diabetes is not uncommon in cats, but it usually never occurs in dogs.
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acuminate - abruptly narrowing to sharp point
acute - sharply pointed
alula - a small winglike group of feathers at the bend of the wing, supported by the anteriormost digit
angulated - with an angle
anisodactyl - three toes in front and one behind, as in perching birds
anteriad - toward the front
apteria - plural of apterium
apterium - unfeathered area between feather tracts
auditory meatus - ear opening
beak - the bill
bipedal - standing on two rather than four legs
booted - not divided into scales (tarsus)
caeca - plural of caecum
caecum - a diverticulum on each side of the gut at junction of small and large intestines, for additional digestion
caudad - tailward (toward the rear)
cere - fleshy area at bill base enclosing nostrils
cloaca - common chamber at end of digestive and urogenital systems
commissure - line formed by meeting of maxilla and mandible
compressed - flattened from side to side
cornified - with a keratinous (horny) covering
coverts - smaller feathers covering large wing and tail feathers
culmen - upper ridge of maxilla
decurved - curved downward toward tip
depressed - flattened from top to bottom
elevated - above front toes (hallux)
emarginate - notched (tail)
filamentous - very long and slender
filoplumes - hairlike feathers
gonys - lower edge of mandible
graduated - feathers successively shorter from center to outside (tail)
gular sac - bare skin on throat and base of mandible
hallux - hind toe
imperforate - separated by a septum (nostrils)
incumbent - at level of other toes (hallux)
lamellate - coarse or fine parallel ridges or plates (at cutting edge of bill)
lobate - with lobes (toes)
lore - area between eye and bill
mandible - lower bill
maxilla - upper bill
nares (sing., naris) - nostrils
nictitating membrane - "third eyelid" drawn over the eye to clean it
notched - with a notch, like a pointed bite taken out of it (bill, tail)
obtuse - wide-not very sharply pointed
operculum - fleshy partial covering over nostril
palmate - completely webbed (3 toes connected)
pamprodactyl - all four toes in front, as in swifts
pectinate - comblike (structure on one side of central toenail)
perforate - continuous with other side (nostrils)
posteriad - toward the rear
primaries - 9-10 or more outermost flight feathers, attached to hand
pteryla - feather tract
pterylae - plural of pteryla
raptorial - feet with long, strong toes and long, sharp, curved claws
rectrices - plural of rectrix
rectrix - tail feather
recurved - curved upward toward tip
remex - large flight feather
remiges - plural of remex
reticulate - with small netlike scales (tarsus)
rhamphotheca - horny covering of bill
rictal - referring to the corners of the mouth
scutellate - with large transversely oriented scales (tarsus)
secondaries - flight feathers attached to forearm (ulna)
semipalmate - webbed only at base (toes)
serrate - with teeth like saw (cutting edge of bill)
spatulate - spoon-shaped (bill)
sternum - the large bone underlying the breast
syndactyl - two front toes partially joined, as in kingfishers
tarsi - plural of tarsus
tarsometatarsus - the bone underlying the tarsus
tarsus - lowest segment of leg, before toes
terete - round in cross section
tertials - flight feathers attached to upper arm (humerus)
tibia - segment of leg that protrudes from feathers, above "ankle"
tomium - cutting edge of both maxilla and mandible
totipalmate - all 4 toes connected by web
uropygial gland - papilla on top of uropygium that secretes oils for preening
uropygium - the fleshy posterior end supporting the tail
vent - opening of cloaca
zygodactyl - two toes in front and two behind, as in woodpeckers
This information is provided by the Slater Museum of Natural History.
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Absence Seizure: Also called a Petit Mal Seizure. A seizure of such brief duration that it is difficult to recognize. According to who you talk to, absence seizures are either very rare in dogs or unrecognized.
AED: Anti-epileptic drug. Also called anticonvulsant or antiseizure drugs. Examples would be phenobarbital and potassium bromide.
Allopathy: The traditional approach to treatment that most veterinarians practice; treating the disease by supressing its symptoms or attempting to destroy the microbes associated with the condition; the opposite of homeopathy. Sometimes called the Western approach.
Ataxia: Uncoordination that is caused by temporary or permanent neurological impairment. A side-effect of some AEDs that can diminish with time.
Aura: A sensation or warning that a seizure is about to occur. See Pre-ictal.
BID: Giving medication twice per day. Example: 30 mg BID means that 60 mg is given a day.
cc: Cubic centimeter. Same as a millileter (ml).
Clonic: Movements during a generalized seizure which includes paddling and/or chewing.
Cluster Seizures: More than 1 seizure in a 24 hour period.
CNS: Central Nervous System
Complex Partial Seizure: Seizures that are associated with bizarre or complex behaviors that are repeated during each seizure. These behaviors can last for minutes or hours and can also be followed by a generalized seizure. Thought to be associated with Secondary Epilepsy.
Efficacy: Effectiveness. Usually refers to the effectiveness of an AED in controlling seizures.
Epilepsy: Refers to recurrent seizures that have a specific neural origin in the cerebral cortex.
Focal Seizures. Also called partial seizures. These seizures affect a part of the brain and thus just a part of the body -- like the flicking of an ear. Focal seizures are more likely from secondary epilepsy than primary.
Generalized Seizure: Also called Tonic-Clonic seizures. If the whole brain is involved in the seizure, it is a generalized seizure. Can be Grand Mal or Mild, but are usually associated with primary epilepsy. See Clonic and Tonic.
Grain: 64.798918 mg. Sometimes referred to as 60 mg, 62 mg, 64 mg or 65 mg. The term comes from the weight of a grain of wheat.
Grand Mal Seizure: Also called Tonic-Clonic. This is a generalized seizure, associated with primary (idiopathic) epilepsy.
Half-Life: The time that it takes for one half of the original concentration of a given drug to dissipate through the body. The shorter the half-life of a drug, the more frequently you have to administer the drug.
KBr: Potassium Bromide. An AED.
Kindling: A process where having repetitive seizures lowers the threshold for having more seizures. This is one reason for getting early control of the seizures.
Holistic: The approach of taking into consideration the whole body and environment when offering treatment. Sometimes called the Eastern approach.
Homeopathy: A system of medical treatments based on the theory that certain diseases can be cured by stimulating the body's own defenses against the illness; the opposite of allopathy.
Ictus (Ictal): The actual seizure.
Idiopathic Epilepsy: Seizures for which there is no known cause. Also called primary, inherited, genetic or true epilepsy.
Inter-ictal: The time period between seizures.
Levels: This refers to the results from monitoring the AED serum concentration in the blood. Also called blood levels, serum levels. See Trough and Peak levels.
Mirroring: A process where seizures which start on only one side of the brain can in time 'mirror' themselves on the other side of the brain thus increase the frequency of the seizures. This is one reason for obtaining early control of the seizures.
ml: Milliliter. Same as a cc (cubic centimeter).
NaBr: Sodium bromide. An AED.
Nonepileptic Seizures: Seizures that can be identified as either nonneurogenic (ie:cardiac, metablic disturbances, recurrent abdominal problems) and neurogenic (ie: narcolpesy, vestibular disease, myasthenia gravis) in origin.
Partial Seizure: See Focal seizure.
PB: Phenobarbital. An AED.
Peak Level: Either the results from or the testing of the AED blood serum values when it is at its highest in the dog's blood. This value is of concern where toxicity might be an issue. For PB levels, the peak is taken 4-6 hours after PB dosing. Giving the PB with food can add another 2 hours to the peak time.
Petit-Mal Seizure: See Absence Seizure.
Polydipsia: excessive thirst - a possible side effect of being on some AEDs.
Polyphagia: excessive hunger - a possible side effect of being on some AEDs.
Polyuria: excessive urination - possible side effect of being on some AEDs.
Post-ictal: The period after a seizure. Can last for minutes or days. The dog can be temporiarily blind, restless, confused, disoriented, confused. Sometimes this is the only indication that the dog has had a seizure.
Pre-ictal: The period prior to the start of the seizure. Sometimes called aura. Some of the signs are restlessness, nervousness, whining, trembling, salivation, affection, wandering, hiding, hysterical running and apprehension.
Primary Epilepsy: See Idiopathic Epilepsy. Also known as genetic, inherited or true epilepsy.
Prodrome: The period (hours to days) before a seizure. Extra AEDs given during this period might help reduce the severity of the seizure or eliminate it.
Rescue Remedy: A homeopathic remedy from Bach Flower Essences (available at most Health Food Stores) that can help lessen the effects during the post-ictal or the actual seizure if given during the pre-ital period. No scientific studies have been done on this, however for many it DOES work .
Secondary Epilepsy: Epilepsy for which a cause can be determined. Usually found in dogs under 1 year of age and over 5 years of age.
Seizure: Also called convulsion, ictus, fit. The brain cells work together, communicating by means of electrical signals. When there is an abnormal electrical discharge from a group of cells, the result is a seizure. Seizures are either epileptic or nonepileptic.
Seizure Threshold: The level at which dogs will have a seizure. It is suggested that this level is inherited. Lowering the threshold (though drugs like acepromazine, or through kindling), makes seizures more likely to occur. Raising the threshold (using drugs like phenobarbital or KBr) will make seizures less likely to occur.
SID: Giving medication once a day. Example: 60 mg SID would be giving 60 mg all at once, one time a day. (Veterinary term only)
Status: Status epilepticus is defined as more than 30 minutes of (1) continuous seizure activity or (2) two or more sequential seizures without full recovery between seizures. More than 3 major seizures within a 24 hour period should be considered a serious condition that may evolve into status and should be treated. The 30 minute duration in the above definition was chosen because detrimental effects begin to occur after this time. These effects include systemic effects such as abnormal breathing, blood pressure and heart rate, and blood glucose, in addition to body temperature. Also, prolonged abnormal electrical activity within the brain can cause persistent brain damage. These changes tend to be reversible during the 30 to 60 minute period of continuous seizure activity but after 60 minutes, death of nerve cells occurs.
TID: Giving medication three times per day. Example: 30 mg TID would be giving a total of 90 mg a day.
Tonic: The phase of a generalized seizure where the dog falls, loses consciousness and extends its legs rigidly. In a mild generalized seizure, the dog may not lose consciousness and could have little or no extension of the legs.
Tonic- Clonic: See Generalized Seizure.
Threshold: See Seizure Threshold.
Trough Level: Either the results from,or the testing of the AED blood serum values just before the next medication dosage is given. It is at this time that the AED is at its lowest level in the blood.
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Alanine Aminotransferase (ALT)
Alanine Aminotransferase (ALT) The enzyme alanine aminotransferase (ALT)
is present in significant quantities in the hepatocytic cytoplasm of
dogs, cats, and primates. ALT catalyzes a reaction that transfers an
amino group from an amino acid to a keto acid, providing a nitrogen
source for the urea cycle.
Albumin
Albumin makes up 35-50% of the total serum protein in most animals.
Synthesized by the liver, albumin is catabolized by all metabolically
active tissues. Albumin is the primary protein affecting the colloid
osmotic activity of plasma and a major transport protein for plasma
constituents. Toxic materials in the body may be detoxified and
inactivated through albumin binding.
Alkaline Phosphatase (ALP)
Alkaline phosphatases are a group of nonspecific enzymes that hydrolyze
many types of monophosphate esters in most cells. The natural
substrate(s) of ALP is currently unknown. High concentrations of
alkaline phosphatases are found in osteoblasts, intestinal mucosa, renal
tubule cells, liver, and placenta. Each tissue has its own ALP isoform.
Amylase
Alpha-amylases are enzymes that catalyze the hydrolysis of complex
carbohydrates into maltose and residual glucose. Amylase is primarily
synthesized in acinar cells of the pancreas and is secreted into the
pancreatic duct system, where it is transported to the intestinal tract.
Additional amylase activity is found in the intestines, kidneys, and
uterus.
Anemia
Anemia with reticulocytosis or polychromasia is described as
regenerative or responsive. This type of anemia occurs when the bone
marrow is actively producing RBCs. Findings that indicate regenerative
anemia include polychromasia, reticulocytosis, and hypercellular bone
marrow with a low myeloid:erythroid ratio. The presence of regeneration
suggests blood loss or RBC destruction. Regenerative anemia also denotes
that sufficient time has elapsed for regeneration to occur (2-3 days),
that there are adequate blood-forming elements (iron, appropriate
vitamins, protein) for regeneration, that there are enough erythrocytic
colonies in the bone marrow, and that there is adequate kidney function
to form erythropoietin.
Anemia, Macrocytic Hypochromic
Macrocytic, hypochromic anemia is characterized by abnormally large RBCs
containing subnormal amounts of hemoglobin. It is seen after acute blood
loss or hemolysis. This type of anemia indicates marked RBC
regeneration, but several days must elapse before this response is
noted. Production of reticulocytes in response to anemia contributes to
the pallor, increased MCV and decreased MCHC.
Anemia, Microcytic Hypochromic
Microcytic, hypochromic anemia is characterized by abnormally small RBCs
containing subnormal amounts of hemoglobin. It is caused by iron
deficiency, impaired iron metabolism, or iron depletion from chronic
blood loss. Rarely, portosystemic shunts and chronic inflammation cause
this type of anemia.
Anemia, Nonregenerative
Anemia without reticulocytosis or polychromasia is described as
nonregenerative. During the first 2-3 days after hemorrhage or
hemolysis, anemia may be nonregenerative. The slight anemias of disease
may be nonregenerative. When no response is seen for several days, it
indicates a primary or a secondary bone marrow disorder.
Anisocytosis
Anisocytosis is a variation in RBC size without a change in cell shape.
Slight anisocytosis occurs normally in cats and dogs, and by itself is
not diagnostic. In moderate to marked anisocytosis, RBCs may be
macrocytic or microcytic. Microcytic RBCs occur in immune-mediated
hemolytic anemia, microvascular constriction, early Heinz-body anemia
and iron-deficiency anemia. Macrocytic RBCs occur with regenerative
anemia and rarely with erythrocytic leukemia. Usually macrocytes raise
the MCV. If microcytic anemia is also a regenerative anemia, such as
occurs with Heinz-body anemia, the MCV is normal but the smear shows
marked anisocytosis.
Aspartate Aminotransferase
The enzyme aspartate aminotransferase (AST) catalyzes a reaction that
transfers an amino group from an amino acid to a keto acid, providing a
nitrogen source for the urea cycle. AST is present in many tissues and
is a good indicator of soft tissue damage. The largest sources of AST in
the dog and cat are heart, liver, skeletal muscle, kidneys, brain, and
plasma.
Band Cells (stab cells)
The band cell (also called a stab cell) is an immature neutrophil
occasionally found circulating in peripheral blood. An increase in the
absolute number of bands indicates increased demand due to inflammation.
Increased numbers are termed a uc0 u179 left shift. u178 Slight
increases in bands (300-1,000/ml) may occur in nonsuppurative diseases,
such as hemorrhagic or granulomatous disease. Bands in excess of
1,000/ml indicate an intense purulent exudative process. Human labs
often refer to band cells as u179 stab u178 cells and often
misdiagnose canine neutrophils as band cells because the canine
neutrophil is less lobulated than the human neutrophil.
Basophils
Basophils and tissue mast cells contain granules of histamine and
heparin. These substances initiate inflammation, prevent coagulation and
activate lipoprotein lipase. Basophils may be seen with a variety of
diseases, while the presence of many mast cells on a blood smear
signifies mast-cell neoplasia. Mast cells and basophils are similar in
appearance because both contain purple metachromatic granules. Mast-cell
granules usually stain intensely and are often numerous enough to
obscure the nucleus. Canine and feline basophils contain fewer dark
granules. The granules in feline basophils stain light blue and are
often missing from the cytoplasm, making them difficult to identify on
blood films. Basophils have a tri-lobed nucleus, similar to that of
neutrophils; mast cells have a single, round nucleus.
Blood Indices
Anemia occurs when the number of circulating RBCs is below the normal
level for the age, sex and breed of the species concerned. The
laboratory identifies anemia by low values for the PCV, hemoglobin and
RBC count. We classify anemias by response, cause and cell
characteristics such as cell size, shape and hemoglobin concentration.
The red blood cell indices consist of the mean corpuscular volume (MCV),
mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin
concentration (MCHC). They are used to determine the type of anemia
present in the patient.
Red cell indices are estimations of the size and cellular hemoglobin
concentration of a population of RBCs. Determining the type of anemia
may help select appropriate therapy and monitor the progress of therapy.
Automated blood analyzers often have a built-in function that determines
one or more of the indices; the remaining indices are then calculated
from determined values. The values can be calculated by knowing the PCV,
hemoglobin level and RBC count. The MCHC and MCH are high at birth but
decrease to adult values in 2 months.
Calcium
Calcium is important in both extracellular and intracellular functions.
Although approximately 99% of the body's calcium is contained in teeth
and bone, calcium ions are also required for muscle contraction, blood
coagulation, enzyme activation, nerve impulse transmission, and changes
in cell membrane and capillary permeability.
Chloride
Chloride is an electrolyte. When combined with sodium it is mostly found
in nature as "salt." Chloride is important in maintaining the normal
acid-base balance of the body and, along with sodium, in keeping normal
levels of water in the body. Chloride generally increases or decreases
in direct relationship to sodium, but may change without any change in
sodium when there are problems with too much acid or base in your body.
For example, the stomach produces large amounts of hydrochloric acid,
which contains chloride; vomiting expels both acid and chloride.
Chloride is taken into the body through food. Most of the chloride is
absorbed by the gastrointestinal tract, and the excess is excreted in
urine. The normal blood level remains steady, with a slight drop after
meals (because the stomach produces acid after eating, using chloride
from blood).
Cholesterol
Cholesterol is a major precursor of cholesterol ester, bile acids, and
steroid hormones and is a component of plasma membranes. The rate of
cholesterol biosynthesis in the liver is indirectly proportional to
dietary intake. Levels of cholesterol in the body are indirectly
controlled by thyroid hormone, which stimulates bile acid production.
Since bile acids are synthesized from cholesterol, cholesterol
concentrations vary inversely with thyroid hormone activity.
Creatine Kinase
Creatine Kinase is an enzyme found in the heart, brain, and skeletal
muscle. Enzymes are proteins that help cells perform their normal
functions. In muscle, for example, CK helps cells make the energy needed
to move. CK occurs in three major forms, called isoenzymes: CK-MB (found
mostly in your heart muscle), CK-BB (found mostly in your brain), CK-MM
(found in your heart and other muscles). CK in the blood comes mainly
from your muscles. The CK in your brain almost never gets into the
blood.
Creatinine
Creatinine is the end product of creatine catabolism. Creatine is formed
from arginine and glycine in a two-step process taking place in the
pancreas, kidneys, and small intestine (first step) and the liver
(second step). Creatine circulates in the blood and is taken up by the
muscle where it stores energy and becomes phosphocreatine. Creatinine is
formed during the breakdown of phosphocreatine and is found throughout
the body water. In addition to endogenous creatinine, a small quantity
of creatinine is consumed by eating animal tissues. The major route of
creatinine excretion is through the kidneys, with some creatinine
excreted through the gastrointestinal tract.
Differential White Blood Cell Count
In a differential WBC count, the number of each leukocytic cell type is
reported as a percentage of the total WBC count. To determine absolute
numbers of each cell type, individual (100-200) WBCs are identified and
reported as a percentage of the total WBC count. This percentage is then
multiplied by the total WBC count to obtain absolute numbers of each
cell type. The 5-part traditional system classifies the cells into
neutrophils, lymphocytes, monocytes, eosinophils and basophils. Immature
forms are classified separately.
The VetScan HMT gives a 3 part differential count. It groups all the
granulocytes (neutrophils, eosinophils & basophils), but differentiates
the lymphocytes and monocytes. A Percent Differential reports each cell
type and a percent of the total count. An absolute differential count
multiplies the percent count by the number of total WBCs. A good hand
count evaluates 100-200 cells. A machine count does many more. An
absolute count gives a more accurate representation of the circulating
cells. It is determined by multiplying the percent of each cell by the
total white blood cell count. The differential count is used to disclose
inflammatory and hormonal responses.
Direct Bilirubin
Bilirubin is an orange-yellow pigment found in bile. It is formed when
hemoglobin, the red-colored pigment of red blood cells that carries
oxygen to tissues, breaks down. Small amounts of bilirubin are present
in blood from damaged or old red cells that have died. In general,
bilirubin can be combined or conjugated to a protein called albumin, in
which case, conjugated bilirubin is often referred to as direct
bilirubin. Bilirubin that is not attached to the protein is called
indirect bilirubin. Each type of bilirubin can give a better picture of
the present disease. Direct bilirubin usually indicates that there is a
blockage from the liver into the bile duct. Indirect bilirubin indicates
that the liver cannot process the bilirubin or there may be a rupture in
a large number of red blood cells and the resultant release of bilirubin
overwhelms the liver.
Eosinophils
Eosinophils are WBCs with numerous functions. They are parasiticidal,
help regulate allergic and inflammatory responses by inhibiting mast
cell release of histamine and serotonin, detoxify histamine at the site
of antigen-antibody reactions, regulate the intensity of IgE reactions,
and have some phagocytic activity against invading bacteria. Their
granules contain potent cytotoxic proteins and lipids that are active in
almost all types of inflammation and tissue injury. Eosinophils are
easily recognized on stained blood smears by their large yellow-orange
granules. They normally occur in small numbers in peripheral blood.
Fibrin
Fibrin is a filamentous protein that is formed as the blood clots. It is
deposited in filaments that entangle with blood cells and platelets to
form a clot.
Gamma Glutamyl Transferase
The physiological functions of gamma glutamyl transferase (GGT) are
thought to be glutathione metabolism, amino acid membrane transport, and
foreign compound detoxification. Concentrations of GGT are found in the
kidneys, pancreas, liver, gallbladder, and intestines. The highest
concentrations of GGT are found in the kidneys and pancreas; however,
GGT in the blood is believed to be primarily from the liver.
Globulin
In the late nineteenth century, it was discovered that there were two
different proteins in serum. These proteins were named albumin and
globulin. Since then the use of electrophoresis has aided in the
identification of over 22 individual plasma proteins, many of which are
subsets of globulin. As a result of the pre-dominance of these two
protein types among total protein, an approximation of the globulin
concentration can be easily determined by subtracting the albumin
concentration from the total protein concentration.
Globulin synthesis occurs in plasma cells, lymphocytes, and the liver.
The major fractions of globulin are termed alpha, beta, and gamma. Alpha
and beta globulins mainly carry various lipids, lipid-soluble hormones
and vitamins, and other lipid-like substances in the plasma. Two other
alpha globulins, ceruloplasmin and haptoglobin, are carriers of copper
and hemoglobin, respectively. A beta globulin, transferrin, is an iron
carrier. The gamma globulins consist primarily of the immunoglobulins.
Glucose
Glucose is normally the only sugar found in the blood. Blood glucose
concentrations are kept within a relatively narrow range by such factors
as hepatic and renal uptake and release, glucose removal by peripheral
tissues, hormone influences on uptake and release, and intestinal
absorption. The only endogenous sources of glucose are the liver and
kidneys which convert glucose-6-phosphate to glucose. Insulin is the
main hormone that affects glucose blood levels.
Granulocytes
Granulocytes are WBCs that contain cytoplasmic granules. These include
neutrophils, eosinophils and basophils. These cells are produced in the
bone marrow. When we count granulocytes we mainly estimate the
neutrophil numbers and assume that an increased granulocyte count
indicates a neutrophilia and a decreased count indicates a neutropenia.
HDL Cholesterol
HDL is one of the classes of lipoproteins that carry cholesterol in the
blood. HDL is considered to be beneficial because it removes excess
cholesterol and disposes of it. Hence HDL cholesterol is often termed
"good" cholesterol. The test for HDL measures the amount of
HDL-cholesterol in blood.
Hematocrit
The Hematocrit (HCT) and the Packed Cell Volume (PCV) indicate the
percent of red blood cells in a unit of whole blood. They are equivalent
measurements. The VetScan HMT calculates the HCT. It is equivalent to
the manual centrifuge packing of red cells called the packed cell volume
(PCV). When a blood sample is centrifuged (Spun Hematocrit), it
separates into 3 layers: an upper layer of plasma; a middle layer of
WBCs and thrombocytes (buffy coat); and a bottom layer of packed RBCs.
Technically, the hematocrit is a measure of all the cellular elements of
blood (WBCs, thrombocytes, RBCs). By common usage, however, it has
become synonymous with packed cell volume (PCV). See also Packed Cell
Volume.
Hemoglobin
Hemoglobin (Hb) is the oxygen-carrying pigment formed by developing RBCs
in the bone marrow. The hemoglobin value of a blood sample is
approximately one-third of the PCV. Variations from this indicate a
laboratory error, hemolysis or abnormalities, such as Heinz bodies or
lipemia. Altered hemoglobin may form Heinz bodies or crystals.
Determination of hemoglobin provides no clinical advantage over
measurement of the PCV other than allowing the determination of Mean
Corpuscular Hemoglobin (MCH) and Mean Corpuscular Hemoglobin
Concentration (MCHC).
Immature RBC
Immature RBCs include reticulocytes and nucleated red blood cells.
Reticulocytes are indicated on the VetScan HMT by a high MCV and a high
RDW. Occasionally immature cells retain their nuclei and are counted by
the VetScan HMT as WBCs.
Left Shift
The term left shift indicates increased numbers of circulating immature
neutrophils (band cells, metamyelocytes, myelocytes). These cells cannot
be differentiated by automatic cell counters. A regenerative left shift
is characterized by band cells and increased numbers of mature
neutrophils. The number of immature neutrophils does not exceed 10% of
the mature neutrophils, and no young cells, such as metamyelocytes, are
present.
A degenerative left shift is characterized by circulating band cells
that exceed 10% of the segmented neutrophils, in conjunction with
decreased numbers of neutrophils or the presence of very young cells,
such as metamyelocytes or myelocytes. In a degenerative left shift, the
total WBC count may vary from below normal to slightly elevated. A
degenerative left shift is an unfavorable prognostic sign.
Leukocytes
Leukocytes are synonymous with "white blood cells" and may be classified
as one of the following: neutrophils, eosinophils, monocytes,lymphocytes
or basophils. These include both the granulocytes and the mononuclear
cells of the lymphoid system. A total WBC count is the sum of all
leukocytes.
Leukocytosis
Leukocytosis is an increased number of WBCs. It is usually caused by an
increase in the number of circulating neutrophils (neutrophilia), though
lymphocytosis (especially with leukemia) occasionally produces
leukocytosis. Absolute values of individual WBC types provide much more
diagnostic specificity than a simple WBC count. Exercise, fear and
digestion cause physiologic leukocytosis. Infection, rapidly growing
neoplasms, acute hemolysis, hemorrhage, intoxication, leukemia and
trauma cause pathologic leukocytosis.
Leukopenia
Leukopenia indicates a decreased total WBC count. It is usually
characterized by decreased numbers of circulating neutrophils. The most
common causes of leukopenia are excessive consumption in an inflammatory
process and primary bone marrow disease. Persistent leukopenia is a poor
prognostic sign.
Leukemia
Leukemia implies neoplastic cells in the peripheral blood. It may occur
in myeloproliferative and lymphoproliferative diseases. In
myeloproliferative diseases immature precursers of red blood cells,
granulocytes, are seen on stained blood smears. In lymphoproliferative
diseases, large numbers of immature lymphocytes are present in
peripheral blood smears.
Lymphocytes
Lymphocytes in the blood are a mixed population of B-cells and T-cells.
They are the major cellular component of immunity in the body.
B-lymphocytes synthesize antibodies that are responsible for humoral
immunity. T-lymphocytes are the principal component of cellular
immunity. Lymphocytes also participate in immune regulation and
surveillance, and some are cytotoxic.
Lymphocytosis
Lymphocytosis indicates increased numbers of circulating lymphocytes.
Pathologic lymphocytosis occurs in chronic inflammation, recovery from
acute infection, lymphocytic leukemia, and hypoadrenocorticism.
Lymphocytosis usually indicates a strong immune stimulus of some chronic
duration from a bacterial infection, viremia or immune-mediated disease.
Lymphocytic leukemia may or may not be accompanied by lymphocytosis.
Lymphocytosis not associated with disease occurs with physiologic
leukocytosis, in healthy cats from excitement, immature age-related
responses in young puppies and kittens, and sometimes following
vaccination.
Lymphopenia
Lymphopenia indicates decreased numbers of circulating lymphocytes. It
may occur with acute severe disease, some viral diseases (canine
distemper, hepatitis, parvovirus and coronavirus infections, feline
panleukopenia, FeLV infection), stress-related corticosteroid response,
and loss of lymph into the gut (chylothorax, lymphangiectasia).
Mean Corpuscular Hemoglobin Concentration (MCHC)
MCHC measures the average concentration of hemoglobin in RBCs. Increases
are usually caused by hemolysis. Decreases are termed hypochromasia and
are seen in reticulocytosis and iron deficiency anemia.
Mean Corpuscular Hemoglobin (MCH)
The MCH is the average amount of hemoglobin in each RBC. This calculated
index is increased with hemolysis. Decreases are termed hypochromasia
and are seen with reticulocytosis and iron deficiency.
Mean Cell Volume (MCV)
The MCV is the average volume of a single RBC. It is determined by
direct measurement with an electronic cell counter such as the VetScan
HMT. Increases are usually due to reticulocytes and indicate a
responsive anemia.
Mean Platelet Volume (MPV)
The MPV is a machine calculation of platelet size. In thrombocytopenic
dogs, increased mean platelet volume gives indirect evidence of
increased megakaryocyte response. High mean volume (>12 fl) indicates
increased response but decreased volume (<12 fl) is not accurate in
predicting lack of bone marrow megakaryocyte production.
Monocytes
Monocytes are the immature blood stage of tissue macrophages. Increased
numbers occur in response to inflammation. Their main function is
phagocytosis of foreign material, cellular debris and pathogens that are
not effectively controlled by neutrophils. They engulf intracellular
organisms and those causing a granulomatous inflammatory response. They
are effective scavengers, removing tissue debris, cellular remnants and
foreign material. Monocytes are also active in regulating the immune
response, processing antigen, and activating killer cells and
macrophages. Monocytes are the most commonly misidentified leukocyte in
blood smears, often being placed into the lymphocyte category.
Monocytosis
Increased numbers of circulating monocytes (monocytosis) occur in
chronic suppurative, pyogranulomatous, necrotic, malignant, hemolytic,
hemorrhagic or immune-mediated diseases. Monocytosis also occurs in dogs
as a corticosteroid-induced response from stress, adrenal hyperfunction
or exogenous corticosteroids. Some animals with chronic disease have
persistent monocytosis. Decreased numbers of circulating monocytes
(monocytopenia) is rare and has no diagnostic significance.
Nucleated Red Blood Cells, (nRBC)
Nucleated RBCs (nRBCs) are larger and more immature than reticulocytes
and mature RBCs. These immature, nucleated stages of the erythrocyte
generally occur within the bone marrow, and are rarely observed in the
peripheral blood of normal dogs and cats. They appear as metarubricytes
in small numbers in response to acute blood loss or anemia. Nucleated
RBCs without concurrent anemia or reticulocytosis are a sign of disease.
They are found in splenic disease, extramedullary hemopoiesis, lead
poisoning, hyperadrenocorticism, leukemia and bone marrow disease.
Circulating nucleated RBCs can be metarubricytes or younger cells, such
as rubricytes. RBCs of birds and reptiles are all nucleated and are
counted as WBCs by automatic counters.
Neutrophils
Neutrophils phagocytize and kill microorganisms. They also initiate and
modify the acute inflammatory process, cause tissue damage and are
cytotoxic. Production and storage in the bone marrow, margination of
cells in the capillary beds, and the demands of peripheral tissues
affect the numbers of circulating neutrophils.
Neutropenia
Neutropenia indicates decreased numbers of circulating neutrophils. It
may be due to insufficient production or increased destruction of
neutrophils. Conditions that cause neutropenia include endotoxemia,
viral infections, overwhelming bacterial infections, and administration
of drugs that cause bone marrow suppression.
Neutrophilia
Neutrophilia indicates increased numbers of circulating neutrophils. It
can be physiologically induced by exercise and corticosteroids, or
pathologically induced by infections and tissue destruction. The primary
differential diagnoses for neutrophilia are inflammation (both septic
and non-septic), stress, exercise or excitement.
Packed Cell Volume (PCV)
The packed cell volume (PCV) or hematocrit (Hct) is a measure of RBC
numbers, expressed as a percentage of the total volume of blood. The
PCV, by common usage, has become synonymous with the Hct. Traditionally
the PCV is obtained by centrifuging an anticoagulated blood sample (spun
crit); with automated counters this value is calculated from the
measured Mean Corpuscular Volume (MCV) and RBC count. This is the reason
that laboratory values may differ slightly from in-clinic values. The
column of packed RBCs (PCV) is measured in millimeters and expressed as
a percentage of the total blood volume. Anemia exists when the PCV falls
below the reference range for the species. Hemoconcentration may exist
when the PCV exceeds the reference range. There is normally a 3:1 ratio
of PCV to hemoglobin value.
Platelet clumping
Platelet clumping is an aggregation of thrombocytes that produces
inaccurate counts with electronic counters. This is caused by activation
of the platelets from poor collection but sometimes occurs spontaneously
in cats. Storage in EDTA (lavender top tubes) may increase this
tendency. Rapid processing with electronic counters decreases this
tendency. The histogram may show an abnormal distribution of large cells
indicating platelet clumping. Because of this clumping in samples the
reference labs usually give only an estimation of platelet numbers as
seen on blood smears. An adequate count of 8-10 platelets/100X objective
field would suggest platelet numbers greater than 150,000.
Thrombocytopenic slides show <7 per 100X objective indicating counts
less than 100,000.
Platelet Count
Counts below 100,000/ml are significant. Platelets can be counted
directly, or numbers can be estimated from the blood smear (>5 per
oil-immersion field). Decreased platelet numbers (thrombocytopenia)
occur with disseminated intravascular coagulation, bone marrow
depression, autoimmune hemolytic anemia, systemic lupus erythematosus
and severe hemorrhage. Thrombocytosis (increased platelet numbers) is
caused by excess bleeding (from trauma, blood sucking parasites or
neoplasia), iron deficinecy anemia and myeloproliferative syndromes.
Platelet Distribution Width (PDW)
Platelet distribution width (PDW) is a number that measures platelet
anisocytosis (variation in size). A mixture of large and small platelets
may give a normal Mean Platelet Volume (MPV) but a high PDW. This would
be an indication of active platelet release.
Platelets (Thrombocytes)
Platelets or thrombocytes are small flat disks, which are produced by
megakaryocytes. They adhere to exposed subendothelial collagen within
seconds of injury to form a hemostatic plug. Low platelet counts
predispose an animal to hemorrhage.
Poikilocytes
Poikilocytes are abnormally shaped RBCs. Poikilocyte is a general term
that encompasses all categories of abnormal RBC shapes, including more
specific terms, such as echinocyte, acanthocyte, schizocyte and
crenation. RBC distortion may occur with improperly prepared blood films
and should not be confused with poikilocytosis. Poikilocytosis is a
nonspecific change seen in chronic blood loss, iron-deficiency anemia,
diseases characterized by RBC fragmentation, and chronic lead poisoning.
A stained blood smear will show the abnormally shaped RBCs.
Polycythemia
Polycythemia is an increase in the red cell mass of the blood. This is
seen as an increase in PCV, hemoglobin concentration and RBC count.
Absolute polycythemia results from increased bone marrow production of
RBCs and may be primary, as with polycythemia vera or myeloproliferative
disease, or secondary to hypoxia and renal disease. Absolute
polycythemia must be distinguished from relative polycythemia that
occurs with dehydration (high plasma protein), hypovolemia (low plasma
protein), shock or splenic contraction (normal plasma protein).
Potassium
Potassium and sodium are the two cations mainly responsible for the
osmotic pressures of intracellular and extracellular fluid (ICF and ECF,
respectively). Sodium, found primarily in ECF, is actively moved from
ICF to ECF by sodium-potassium pumps in the cells. The ICF is the
principal location of potassium, where it can not be clinically
measured. The movement of potassium across the cell membrane is crucial
to cardiac and neuromuscular excitability. Membrane potential is altered
by changing the ratio of ICF potassium to ECF potassium. Homeostasis of
potassium is controlled by the ICF : ECF potassium ratio and by body
intake and output. The ICF : ECF ratio is affected by acid-base balance,
glucose and insulin administration, exercise, and catecholamine release.
Red Blood Cells (RBC)
Red blood cells (RBCs) transport oxygen from the lungs to body tissues.
Their production is stimulated by erythropoietin, secretion of which is
controlled by the blood oxygen tension. Erythropoietin stimulates
maturation of RBC precursors in bone marrow into mature RBCs. Blood
loss, parasitism, renal failure, RBC damage, chronic inflammatory
disease, hematopoietic malignancies and insufficient dietary iron,
copper or vitamin B12 cause a deficiency of RBCs (anemia). Shock, fluid
loss or increased RBC production can cause increased RBC numbers
(polycythemia). Dehydration or protein fluid extravasation causes a
relative decrease in the fluid portion of the blood and a relative
increase in the cellular portion. Carbon monoxide, lung disease, heart
disease and high altitude cause excessive RBC production by stimulating
erythropoietin secretion. Erythrocytic malignancies and polycythemia
vera cause excessive RBC production without normal stimulation.
Red Cell Distribution Width (RDW)
The red cell distribution width is an electronic measure of anisocytosis
(variation of cell size). It increases where the degree of anisocytosis
is increased. In regenerative anemia, it increases when large cells are
produced even before the MCV exceeds the reference range. It also
increases when small cells are produced as with iron deficiency anemia.
Reticulocytes
Reticulocytes are immature RBCs without a nucleus. They retain a fine
network of endoplasmic reticulum that stains with reticulocyte stains.
These immature cells are slightly larger than mature RBCs and normally
circulate in small numbers. Elevated numbers of circulating
reticulocytes (reticulocytosis) occur in chronic hemorrhagic or
hemolytic anemia with increased erythropoiesis. A lack of circulating
reticulocytes in chronic anemia indicates bone marrow depression.
Reticulocytosis without evidence of anemia may indicate reduced
oxygenation of blood. This leads to increased erythropoietin levels,
which in turn stimulate erythropoiesis and release of reticulocytes from
the bone marrow. Reticulocytes are not counted by the VetScan HMT but
are suggested by a high MCV. When present they indicate the animal is
responding to blood loss by red cell regeneration.
Right Shift
The term right shift indicates increased numbers of circulating
hypermature neutrophils in neutrophilic blood samples. These are cells
showing hypersegmentation. This is usually seen in noninfectious
inflammatory processes such as inflammation secondary to a malignancy.
The 3X Rule
Hemoglobin x 3 = Hematocrit ( 'b1 2%) In normal blood samples, the
hemoglobin is approximately one third the hematocrit. This relationship
can be used to cross check the accuracy of the blood counts. If
abnormal, the sample should be checked for hemolysis or Heinze bodies.
Thyroxine
Thyroxine is a hormone synthesized in and secreted by the thyroid gland.
The primary secretory form of the thyroid hormone is tetraiodothyronine
(T4), although some triiodothyronine (T3) is also secreted into the
blood. The ratio of T4 to T3 is 25:1 in canine plasma. Once in the
blood, T4 and T3 are bound by transport proteins. The primary binding
protein is thyroxine-binding globulin (TBG) in the dog and albumin in
the cat. Upon delivery to the target cell, T4 is deiodinated to T3 at
the cell surface. T3 is the biologically active form of the thyroid
hormone and more readily enters the target cell.
Total Bilirubin
Bilirubin is an orange-yellow pigment found in bile. It is formed when
hemoglobin, the red-colored pigment of red blood cells that carries
oxygen to tissues, breaks down. Small amounts of bilirubin are present
in blood from damaged or old red cells that have died. In general,
bilirubin can be combined or conjugated to a protein called albumin, in
which case, conjugated bilirubin is often referred to as direct
bilirubin. Bilirubin that is not attached to the protein is called
indirect bilirubin.
Total Cholesterol/HDL ratio
Cholesterol is a structural component in cell membranes as well as in
plasma lipoproteins. It is also used to form steroid hormones, bile acid
and glucocorticoids. Typically, the body synthesizes most of the
cholesterol the body needs. The cholesterol in our diet can increase the
levels in our body. Too much cholesterol, however, is implicated in
coronary artery diseases, which can lead to heart attacks. HDL is one of
the classes of lipoproteins that carry cholesterol in the blood. HDL is
considered to be beneficial because it removes excess cholesterol and
disposes of it. Hence HDL cholesterol is often termed "good"
cholesterol. The combination of total cholesterol and HDL ratio is used
to determine the risk of developing coronary artery disease.
Total Protein
A total protein assay measures the amount of proteins found in the
plasma. The two major protein components are albumin and globulins.
Plasma proteins play a major role in maintaining colloid osmotic
pressure, and are a source of amino acids. They also bind and transport
a variety of substances including lipids, fatty acids, lipid-like
substances, copper, iron, and hemoglobin.
Triglycerides
Triglyceride testing measures the amount of triglycerides in your blood.
Triglycerides are the body's storage form for fat. Most triglycerides
are found in adipose (fat) tissue. Some triglycerides circulate in the
blood to provide fuel for muscles to work. Extra triglycerides are found
in the blood after eating a meal 'dcwhen fat is being sent from the gut
to adipose tissue for storage. The test for triglycerides should be done
when you are fasting and no extra triglycerides from a recent meal are
present.
Urea Nitrogen (BUN)
Urea is one of three end products of nitrogen metabolism. Blood levels
of urea are typically low and relatively constant since the primary mode
of urea excretion is through the kidneys. The action of antidiuretic
hormone on the permeability of the medullary collecting duct allows urea
to diffuse into the medullary interstitium. The presence of both urea
and sodium in the interstitium increases the osmotic gradient for water
reabsorption and increases the concentration of the urine.
Uric Acid
Uric acid is a product of the metabolism (breakdown) of purines. Purines
are chemicals that come from both the breakdown of foods and nucleic
acids (DNA) in the body. If uric acid levels in the body are low, there
are no symptoms. Doctors don uc0 u185 t need to test for low levels of
uric acid.
White Blood Cell Count (WBC)
The total WBC count combines circulating numbers of neutrophils,
lymphocytes, monocytes, eosinophils and basophils. Because neutrophils
are the predominant leukocytic cell type, a high total WBC count
(leukocytosis) is generally due to an increase in this cell line.
However, absolute values of individual leukocytic cell lines (found by
performing a differential count and multiplying each cell line
percentage by the total WBC count) often provides more diagnostic
specificity. Leukopenia (decreased WBCs) is generally evident only with
a decrease in neutrophils. Leukocytosis and leukopenia occur with a
variety of diseases. Normal ranges for total WBC counts are printed by
the VetScan HMT and should be similar to textbook ranges. Differential
counts may differ from textbooks and reference labs because the VetScan
HMT groups neutrophils, eosinophils and basophils into one category
(Granulocytes). Lymphocyte and monocyte values should be similar to
textbook values. Top
