July 2017 Case of the Month

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 %


  1. What does rouleaux formation of red blood cells (RBCs) indicate? 
  2. 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?
  3. What pathologic processes can be identified based on the provided chemistry results? What are your differential diagnoses and what diagnostic test would you recommend?

Answers on next page

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