Laboratory data from a jaundiced dog
Case presentation
A 9 year-old female spayed Pomeranian was presented to the Cornell University Hospital for Animals (CUHA) Emergency Service as a referral for markedly increased liver enzymes and cholesterol. The dog presented to the referring veterinarian with a two day history of vomiting, constipation, inappetence, and lethargy. After two days of medical therapy with no improvement, the dog was referred for further diagnostic testing and treatment.
Upon presentation to CUHA, the dog was bright, alert, responsive, and anxious. Vital signs (temperature, pulse, and respiratory rate) were within normal limits. On physical examination, the dog was uncomfortable on abdominal palpation and the liver was palpably enlarged. Jaundice of the skin and sclera OU were also observed. The only other physical examination abnormality was a grade 1/4 luxating right patella. Blood was collected for a complete blood count (CBC) and serum chemistry panel; relevant results of which are presented below. Evaluate the provided results and answer the questions posed below:
| Table 1: Complete hemogram, EDTA | |||
| Test | Result | Reference interval | Unit |
| WBC | 15.7 | 5.7-14.2 | thou/ul |
| Segmented neutrophils | 13.0 | 2.7-9.4 | thou/ul |
| Band neutrophils | 0.0 | 0.0-0.1 | thou/ul |
| Lymphocytes | 0.5 | 0.9-4.7 | thou/ul |
| Monocytes | 2.0 | 0.1-1.3 | thou/ul |
| TP-ref | 9.0 | 5.9-7.8 | g/dL |
| RBC morphology | Moderate rouleaux formation | ||
| Plasma appearance | Marked icterus | ||
| Table 2: Chemistry, serum | |||
| Test | Result | Reference interval | Unit |
| Total protein | 5.2 | 5.3-7.0 | g/dL |
| Albumin | 2.8 | 3.1-4.2 | g/dL |
| Globulin | 2.4 | 1.9-3.6 | g/dL |
| Glucose | 142 | 63-118 | mg/dL |
| ALT | 2698 | 20-98 | U/L |
| AST | 564 | 14-51 | U/L |
| Alkaline phosphatase | 3590 | 17-111 | U/L |
| GGT | 309 | 0-6 | U/L |
| Total bilirubin | 16.3 | 0.0-0.2 | mg/dL |
| Direct bilirubin | 14.1 | 0.0-0.1 | mg/dL |
| Indirect bilirubin | 2.2 | 0.0-0.2 | mg/dL |
| Cholesterol | 782 | 138-332 | mg/dL |
| Creatine kinase | 1478 | 48-261 | U/L |
| Iron | 261 | 78-214 | ug/dL |
| Transferrin saturation | 77 | 23-61 | % |
- What does rouleaux formation of red blood cells (RBCs) indicate?
- What are three explanations for the marked discrepancy between the total protein result on the CBC and chemistry panel in this case? Which result do you think is a better reflection of the patient’s total protein concentration?
- What pathologic processes can be identified based on the provided chemistry results? What are your differential diagnoses and what diagnostic test would you recommend?
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