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Veterinary Clinical Pathology a Case-Based Approach Veterinary Clinical Pathology A Case-Based Approach © 2015 by Taylor & Francis Group, LLC K22449_Book.indb 1 4/4/15 7:35 AM Veterinary Clinical Pathology A Case-Based Approach © 2015 by Taylor & Francis Group, LLC K22449_Book.indb 2 4/4/15 7:35 AM Veterinary Clinical Pathology A Case-Based Approach Kathleen P. Freeman DVM, BS, MS, PhD, DipECVCP, FRCPath, MRCVS RCVS Specialist in Veterinary Pathology (Clinical Pathology) European Veterinary Specialist in Clinical Pathology IDEXX Laboratories Ltd., Wetherby, West Yorkshire, United Kingdom Stefanie Klenner Dr.med.vet., DipECVCP European Veterinary Specialist in Clinical Pathology scil animal care company GmbH Viernheim, Germany © 2015 by Taylor & Francis Group, LLC K22449_Book.indb 3 4/4/15 7:35 AM CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2015 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20150302 International Standard Book Number-13: 978-1-4822-2590-7 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily reflect the views/opinions of the publishers. The information or guidance contained in this book is intended for use by medical, scientific or health-care professionals and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verified. The reader is strongly urged to consult the relevant national drug formulary and the drug companies’ and device or material manufacturers’ printed instructions, and their websites, before administering or utilizing any of the drugs, devices or materials mentioned in this book. This book does not indicate whether a par- ticular treatment is appropriate or suitable for a particular individual. Ultimately it is the sole responsibility of the medical professional to make his or her own professional judgements, so as to advise and treat patients appropriately. The authors and publishers have also attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint. Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any elec- tronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organization that pro- vides licenses and registration for a variety of users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged. Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the© CRC 2015 byPress Taylor Web & Francis site Group,at LLC http://www.crcpress.com Contents Preface vii Contributors ix Broad Classification of Cases xi Abbreviations xiii Approach to Analysis of Cases xv Questions 1 Answers 131 Appendices: 1 Conversion Factors 263 2 Biological Variation 264 Index 267 © 2015 by Taylor & Francis Group, LLC K22449_Book.indb 5 4/4/15 7:35 AM © 2015 by Taylor & Francis Group, LLC K22449_Book.indb 6 4/4/15 7:35 AM Preface This book aims to provide a variety of clinical pathology approach the analysis and interpretation of the data. The cases covering multiple species and submitted by a format, with general assessment of the laboratory data selection of clinical pathologists and clinicians. It is not and questions to be answered regarding its interpretation, meant to cover all possible clinical pathology diagnoses, pathological mechanisms and clinical significance, should but offers a compilation of cases with clinical pathological be of benefit in tying together the clinical pathology results encountered by the contributors. The book was results, the pathophysiological base for these results, their inspired by examples provided to the authors by their interpretation, and further testing or information that may teachers and mentors when discussing cases and their be of benefit for diagnosis, monitoring and/or prognosis. thought processes in order to encourage the development When a contributor uses laboratory results to skilfully ‘tell of their own clinicopathological skills during training. the story’ of the patient and explain the ‘detective work’ of We were further motivated by the need expressed by many the clinician and its interpretation, it is a joy to read! veterinary students and trainees in general veterinary We therefore present a collection of cases with a wide medicine, clinical pathology and internal medicine with variety of clinical pathological abnormalities. Topics whom we have interacted to have wider experience of the include haematology, clinical chemistry, endocrinology, thought processes of experienced clinical pathologists and acid–base and blood gas analysis, haemostasis, urinalysis, clinicians with regard to interpretation of laboratory data. biological variation and quality control. The cases about It was fascinating to see the systematic approaches that quality control are unique for such a book and reflect our each contributor has taken with the cases they have elected deep belief that this is an issue of huge importance for to submit. Although the order of consideration and the all of us. Every laboratory result represents a result with terminology and phrases used by each contributor may some degree of ‘probability’ associated with it, since all differ slightly, there are many common threads that will laboratory results contain some degree of inherent error. be recognised as you read through these cases. You may Knowledge of the nature of such variation (errors) and find that you have ‘favourite’ contributors whose thought how they may influence our laboratory results helps all process and approach you admire, and you may seek to of us to become better pathologists and clinicians. incorporate their style, phrases and approach into your The level of difficulty of the various cases is wide, own clinical repertoire. giving beginners the possibility to start improving their The role of clinicians and clinical pathologists in today’s clinicopathological skills, providing more complicated environment lies in providing context, ‘telling the story’ cases or cases treating unfamiliar topics (e.g. biological and giving meaning in order to tie together the clinical variation) for the more experienced reader and increasing presentation and laboratory data and assure the best learning opportunities for the less experienced. possible patient care. By providing ‘meaning’ for ourselves, We hope that these cases will be of interest to a the owners and our colleagues we are establishing the basis wide audience and provide a resource for continuing for ongoing learning and a way to approach cases that will development of expertise in interpretation of laboratory help all of us to become better practitioners of the art and data. We have endeavoured to ensure that the approaches science of veterinary medicine and to better communicate and information are accurate and that recommendations with our clients, owners and colleagues. for Further Reading are provided for many of the topics. We hope these cases will provide an opportunity for We hope that you will enjoy these cases and the expertise of students, residents, general practitioners and all veterinarians the contributors in presenting them for you. who would like to challenge or improve their skills in veterinary clinical pathology to see various presentations Kathleen P. Freeman of cases and the ways that the contributors of these cases Stefanie Klenner vii © 2015 by Taylor & Francis Group, LLC K22449_Book.indb 7 4/4/15 7:35 AM © 2015 by Taylor & Francis Group, LLC K22449_Book.indb 8 4/4/15 7:35 AM Contributors Natali Bauer, PD Dr. (habil.) DipECVCP Lisle George, DVM, PhD, DipACVIM Justus-Liebig-Universität Gießen University of California Davis School of Veterinary Gießen, Germany Medicine Davis, California, USA Andrea Di Bella, DVM, DipECVIM-CA, CertSAM, MRCVS Karen Gerber, BVSc, Hons BVSc, DipACVP East Grinstead, West Sussex, England (Clinical Pathology), GCertEd Registered Specialist Veterinary
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