Archives

THIS MONTH 
More about Platelets
New Price List
Next Clin Path Club meeting
Clin Path Club Dates for 2001
Your Practice in your Palm
Palm BSAVA Draw Winner
An Inspector Calls
Tail End: "Mind Games Dogs Play with Owners"

More About Platelets 
"`Normal primary haemostasis demands the presence of adequate numbers of fully functioning platelets.’’

Thrombocytopenia can arise in any one, or a combination of, three ways:

• · Decreased production.
• · Increased destruction or utilisation.
• · Sequestration.

One exception to the pattern of bone marrow suppression is seen with oestrogen toxicity, following therapeutic use or in the case of Sertoli cell tumours. Thrombocytopenia may be seen in isolation, or initially accompanied by neutrophilia, although ultimately (2-4 weeks later) neutropenia and non-regenerative anaemia develop.
Thorough history taking, clinical examination and ultimately bone marrow aspiration and core biopsy are central to investigation of persistent pancytopenias.

Increased platelet destruction or utilisation
Premature platelet destruction is probably immune-mediated but not necessarily of ‘primary’ pathogenesis Primary IMT occurs when antibodies are raised specifically against platelet antigens in the apparent absence of any underlying disease or initiating cause. 

Secondary immune-mediated thrombocytopenia can accompany a wide range of conditions including inflammation or infection when presumably antibodies are raised in conjunction with a general `up-regulation’ of the immune system.

Whether the aetiology is primary or secondary, the end result is formation of platelet antigen:antibody complexes that are removed prematurely from the circulation. (Platelet function is also compromised when antibodies block essential receptor sites).

Primary immune-mediated thrombocytopenia appears to be more common in certain breeds, namely Cocker Spaniels, Poodles, German Shepherd Dogs and Old English Sheepdogs.

Secondary immune-mediated thrombocytopenia shows no breed or sex predilection. In addition to inflammatory processes, other possibilities include neoplasia or iatrogenic causes for example following the use of potentiated sulphonamides.

Diagnosis of immune-mediated thrombocytopenia can be based on finding platelet bound anti-platelet antibody but this does not differentiate between primary and secondary disease.

Platelet utilisation: In basic terms this occurs when demand outstrips supply, and the most well known example of this is disseminate intravascular coagulation.(DIC) Other conditions include systemic lupus erythematosus, immune-complex vasculitides and septicaemia. Generally, haemorrhage does not produce thrombocytopenia but as usual, there is one notable exception, and rodenticide toxicity can result in profound thrombocytopenia as well as increased clotting times. This has diagnostic significance as traditionally the combination of thrombocytopenia and increased coagulation profiles was thought to be the hallmark of DIC.

Platelet sequestration
The peripheral platelet count represents around one-third of total in the circulation; the remainder are sequestered within the spleen. Splenomegaly will result in mild thrombocytopenia (the converse of this is rebound thrombocytosis post splenectomy or following splenic contraction). A marked decrease in platelet numbers in patients with splenomegaly should prompt the clinician to suspect other mechanisms are involved.
Sequestration of platelets in the pulmonary vasculature may be seen in patients with sepsis, but again this is not straightforward as decreased production is also a feature of sepsis.

Sue Beck BVMS MRCVS

Find out in the next issue about Thrombopathias
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NEW PRICE LIST

A new issue of the price list was published in February. Here are just some of the changes you can expect:-

• The microbiology section now includes a Test Selection Table to help match sample with the best test code option.

 
• The Avian and Reptile Profile section has been considerably enlarged to reflect the increased interest in “exotics”. The appointment of Romain Pizzi as our consultant in this field has resulted in a marked interest in this service.

 
• The Genetics and DNA section has also been expanded. The tests in this section are being offered in association with VetGen the leading American genetic testing specialist. 

 
• The Virology and Serology section includes additions and changes. We would draw your attention to the new IgG, IgM test for Toxoplasma and the new immunofluorescent tests for Felv and FIV. Also the new range of PCR tests for blood parasites aimed at the PET scheme patients.

 
• You will note that bile acids have been removed from a number of the canine & feline profiles. This decision has been made because random bile acid tests are now considered to be of limited diagnostic value and can be misleading. The test should be done on fasting and post feeding samples or on a fasting sample as part of a liver profile. 

 
• There are a few deletions; Free T4 is no longer available. Alternatives are Total T4 or Free T4 by equilibrium dialysis. The Relaxin pregnancy test has been withdrawn because of variable results. The test is undergoing further development and is available on request but use with caution.

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CLIN PATH CLUB 
The Clin Path Club meetings are open to all veterinary surgeons and veterinary nurses.

Next Meeting: Thursday 9th May 2002 

Venue: Swallow Hotel, Samlesbury, Preston New Road, Preston. (Leave M6 J31, follow A59 signs to Blackburn, hotel just before 1st traffic lights)

Speaker: Simon Swift MA VetMB Cert SAC MRCVS: Clinical Cases in Cardiology - What would you do?

Case book studies: If you would like to present an interesting case please contact Jane Miller on 01253 899215 or e-mail

To book your place, request further information or a location map call Joanne Kenyon on 01253 899215 or e-mail

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CLIN PATH CLUB - Dates for 2002 
Please make a note in your diary of the forthcoming meetings :- 

• Thurs 11th July 2002 Jane Miller BVetMed FRCPath MRCVS: Haematology Workshop: Haematology Case Book- A Practical approach to Haematology in Practice 
• Thurs 12th September 2002 Dr Ian Ramsey BVSc PhD Dip ECVIM MRCVS: Recent advances in the diagnosis and treatment of Canine hyperadrenocorticism
• Thurs 14th November 2002 Dr A Coughlan BVSc Cert VA DSAS (Orth) PhD FRCVS Working up the lame dog "Tricks and Traps"

Quote “An excellent way to top up your CPD"

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Your Practice in your Palm
Personal Digital Assistant PDA, what could a Palm do for you? 

At BSAVA Congress this year we gave away a Palm m105 Personal Digital Assistant as a draw Prize. 
The Palm or Personal Digital Assistant is rapidly becoming an essential part of the busy veterinary surgeons life. In the beginning it starts as an electronic address book progressing to an alternative to your desktop diary and eventually becomes an extension of your desktop PC not to mention your reference library. At first glance these diminutive electronic devices look like no more than a geeky gimmick. But once you discover that they have serious computing power you will soon be making full use of the rapidly growing range of applications available. In combination with your mobile phone they represent a truly effective communications solution with the ability to collect and deliver e-mails, text messages, faxes and web site information. 

But it is as an alternative to the pocket note book and maybe even your reference library where you will probably discover the most valuable contribution to your busy life. It is quite feasible to condense the most frequently thumbed pages from all those reference books on your bookcase into a computing powerhouse no bigger than a pack of playing cards. Lab reference ranges, conversion factors, drug formulary, I could go on but the list is endless. 

Just how useful you will find a PDA depends upon how much effort you are prepared to learning the basics, it’s easier than you may think. Once the gimmicky bit wears off and you find that phone number you didn’t think you had, you will be sold. And it isn’t just a source of information, once you learn the quaint but simple Graffiti script, a form of electronic shorthand you will find yourself taking dictation not just notes.

The Internet is awash with interesting applications for the Palm One of the most interesting is The 5-Minute Veterinary Consult: Canine and Feline offering authoritative coverage and timely answers to all your questions. It is a clinical reference loaded with practical information from leading experts in small animal practice. 
This text is an important resource you can use every day. A quick reference resource of internal medicine in canine and feline health, the book includes: over 700 specific disorders, contributions from nearly 300 leading authorities in the field and 17 section editors covering every specialty of small animal practice. Note there have been some problems with the download of this product from the suppliers site.

If you are interested in uing the Palm PDA's in a veterinary context you should join the PalmVet discussion group in the YahooGroups . One of the most useful Palm websites for Vets is is run by Linda Cochran DVM, there you will find lots of downloads and links of interest. If you have a Palm with an expansion card you will find this a useful link http://staff.unk.edu/s/spradlinb/visor/home.html the site contains some interesting tutorials. And for all things Palm try www.palmgear.com and www.freewarepalm.net

PALM DRAW WINNER
The Winner of the BSAVA Congress Draw for a Palm m105 was :-

Miss Morgan-Jones BVSc MRCVS
Broom Cottage Veterinary Surgery (Willows Veterinary Group)
Wilmslow

Congratulations from all at NWL

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An Inspector Calls

Three days of ferreting, questioning and checking by three highly skilled independent technical auditors. All in the interest of a better service.

It is just 12 months since we received our UKAS ISO 17025 accreditation. We are proud to say that NWL is the first commercial veterinary laboratory to be accredited to this new international standard for testing laboratories. It is just 2 weeks since the UKAS assessors returned for our annual surveillance inspection and assessment. 

Are we still up to the demanding requirements of the Standard? Three days of ferreting, questioning and checking by three highly skilled independent technical auditors will soon find out.

No stone is left unturned. Quality systems are dissected minutely, policies tested and questioned. Test procedures are witnessed and staffed quizzed. Internal and external quality control results are critically reviewed. Equipment maintenance records checked. Calibration certificates for balances, autoclaves, thermometers, weights, pipettes etc checked. The process is exhaustive and detailed but also very constructive and character forming. Laying every aspect of your management and procedures open to criticism and inspection by your peers is a daunting prospect but when completed successfully is highly satisfying. 

Our clients trust us to provide them with results that are of a measurable standard. How do they know they can trust us? When they see the UKAS logo they can be assured that the validity of our test results, the competence of our staff and our quality management system have been assessed and peer reviewed to an internationally recognised standard. 

One day all laboratories will be ISO 17025 accredited. 

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Tail End 
"Mind Games Dogs Play with Owners!" 

Make your humans be patient. When you go outside to go 'pee,'
sniff around the entire yard as your humans wait. Act as if the spot
you choose to go pee will ultimately decide the fate of the earth.

Draw attention to the human. When out for a walk always pick the
busiest, most visible spot to go 'poo.' Take your time and make sure
everyone watches. This works particularly well if your humans have
forgotten to bring a plastic bag.

Wake up twenty minutes before the alarm clock is set to go off
and make the humans take you out for your morning pee. As soon as
you get back inside, fall asleep. (Humans can rarely fall back asleep
after going outside, this will drive them nuts!)

For interested Canines go to http://www.wonderdog.net/