• Low-Cost Veterinary Clinical Diagnostics

    A practical guide to maximizing the diagnostic value of in-house quick assessment tests (QATs)

    In Low-Cost Veterinary Clinical Diagnostics, the authors provide a hands-on resource designed to facilitate healthcare delivery across the spectrum of care.

    Historically, clinicians have been taught to apply the gold standard approach to the practice of medicine. However, recent advances in veterinary medical care and associated technologies have made practitioners question whether a one-size-fits-all approach is truly best. After all, when we perform diagnostic tests, are we testing out of the desire for completeness, to cover all bases for the good of the patient? Or are we testing because we are expected to?

    The reality is that gold standard care is not always advisable and not always possible. In clinical practice, veterinarians frequently encounter obstacles that limit their approaches to case management. Cost of care is a significant constraint that requires practitioners to rethink which diagnostic tests are essential.

    Not every patient requires a complete blood count (CBC), chemistry profile, urinalysis, and fecal analysis to obtain diagnostic value. This text suggests that the “best” approach to case management be determined by the situation, the context, the patient, and the client.

    While sophisticated panels of tests may remain the recommended approach to case management, Low-Cost Veterinary Clinical Diagnostics outlines entry-level, in-house diagnostic blood, urine, fecal, and body cavity fluid tests: how to perform them as well as the breadth and depth of patient-specific data that can be gleaned from quick assessment tests (QATs).

    Readers will also find:

    • A thorough introduction to patient care considerations, communication strategies that facilitate cost-conscious shared decision-making
    • Comprehensive explorations of quick assessment tests (QATs) in hematology, including packed cell volume (PCV), total solids (TS), buffy coat analysis, blood smears, blood glucose, blood urea nitrogen (BUN), saline agglutination tests, and activated clotting time.
    • Practical discussions of quick assessment tests (QATs) involving urine, including urine color, dipstick analysis, specific gravity (USG), and urine sediment analysis
    • Pragmatic evaluation of fecal analysis, including considerations surrounding fecal color, volume, consistency, and odor; saline smears or wet mounts, and fecal flotation.
    • Discussion on body cavity fluid analysis
    • Sample case vignettes, complete with question and answer (Q&A)

    Perfect for veterinary practitioners, veterinary technicians, veterinary and veterinary technician students, Low-Cost Veterinary Clinical Diagnostics offers a quick and easy reference guide to maximizing diagnostic value in those cases where care is cost-prohibitive.

  • About the Authors xiv

    About the Contributors xvii

    Preface xviii

    Acknowledgments xxi

    Part 1 Patient Care Considerations 1

    1 The Gold Standard, Standards of Care, and Spectrum of Care: An Evolving Approach to Diagnostic Medicine 3
    Ryane E. Englar

    1.1 Defining the Gold Standard 3

    1.2 Limitations of the Gold Standard 4

    1.3 Returning to the Case of the Cat with Stranguria: a Different Perspective on Standards of Care 4

    1.4 Limitations to Standards of Care 5

    1.5 Spectrum of Care 6

    References 7

    2 Consultation Room Communication Strategies that Facilitate Dialogue on the Diagnostic Approach to Patient Care 9
    Ryane E. Englar

    2.1 Emergence of Communication as a Clinically Relevant Skill in Human Health Care 9

    2.2 The Evolution of Communication in Veterinary Health Care 10

    2.3 Communication Skills That Are Essential to Diagnosis-Making 11

    2.4 Concepts of Health Literacy and Compliance 13

    2.5 Using Easy-to-Understand (Nonmedical) Language 14

    2.6 Checking in 15

    2.7 Assessing the Client’s Knowledge 17

    2.8 Signposting 18

    2.9 Addressing the Cost of Care 20

    References 22

    Part 2 Quick Assessment Tests (QATS) Involving Blood 27

    3 Packed Cell Volume 29
    Sharon M. Dial

    3.1 Procedural Definition: What Is this Test About? 29

    3.2 Procedural Purpose: Why Should I Perform this Test? 29

    3.3 Equipment 29

    3.4 Procedural Steps: How Do I Perform this Test? 30

    3.5 Time Estimate to Perform Test 33

    3.6 Procedural Tips and Troubleshooting 33

    3.7 Interpreting Test Results 34

    3.8 Clinical Case Example(s): Can We Link to the Cases in Chapter 5? 35

    3.9 Add-On Tests That You May Need to Consider and Their Additive Value 35

    3.10 Key Takeaways 36

    References 36

    4 Total Protein as Measured by Refractometry 37
    Sharon M. Dial

    4.1 Procedural Definition: What Is This Test About? 37

    4.2 Procedural Purpose: Why Should I Perform this Test? 37

    4.3 Equipment 38

    4.4 Procedural Steps: How Do I Perform this Test? 38

    4.5 Time Estimate to Perform Test 42

    4.6 Procedural Tips and Troubleshooting 43

    4.7 Interpreting Test Result 43

    4.8 Clinical Case Example(s) 44

    4.9 Add-On Tests That You May Need to Consider and Their Additive Values 44

    4.10 Key Takeaways 44

    Reference 45

    Suggested References 45

    5 Gross and Microscopic Evaluation of the Buffy Coat 46
    Sharon M. Dial

    5.1 Procedural Definition: What Is This Test About? 46

    5.2 Procedural Purpose: Why Should I Perform this Test? 46

    5.3 Equipment 47

    5.4 Procedural Steps: How Do I Perform this Test? 47

    5.5 Time Estimate to Perform Test 50

    5.6 Procedural Tips and Troubleshooting 53

    5.7 Interpreting Test Results 53

    5.8 Clinical Case Example(s) 54

    5.9 Add-On Tests That You May Need to Consider and Their Additive Value 54

    5.10 Key Takeaways 54

    Reference 54

    6 The Blood Film 55
    Sharon M. Dial

    6.1 Procedural Definition: What Is This Test About? 55

    6.2 Procedural Purpose: Why Should I Perform This Test? 55

    6.3 Equipment 55

    6.4 Procedural Steps: Preparing the Blood Film How Do I Perform This Test? 56

    6.5 Time Estimate to Perform Test 64

    6.6 Procedural Tips and Troubleshooting 64

    6.7 Interpreting Test Results 69

    6.8 Clinical Case Example(s) 70

    6.9 Add-On Tests That You May Need to Consider and Their Additive Value 70

    6.10 Key Takeaways 70

    References 70

    Suggested Bench-Side Reference 71

    7 Blood Glucose 72
    Sharon M. Dial

    7.1 Procedural Definition: What Is This Test About? 72

    7.2 Procedural Purpose: Why Should I Perform This Test? 72

    7.3 Equipment 73

    7.4 Procedural Steps: How Do I Perform This Test? 73

    7.5 A Note on Quality Control 73

    7.6 Procedure for Patient Samples 74

    7.7 Time Estimate to Perform Test 76

    7.8 Procedural Tips and Troubleshooting 76

    7.9 Interpreting Test Results 77

    7.10 Clinical Case Example(s) 78

    7.11 Add-On Tests That you May Need to Consider and Their Additive Values 78

    7.12 Key Takeaways 78

    References 78

    8 Blood Urea Nitrogen 79
    Sharon M. Dial

    8.1 Procedural Definition: What Is This Test About? 79

    8.2 Procedural Purpose: Why Should I Perform This Test? 79

    8.3 Equipment 80

    8.4 Procedural Steps: How Do I Perform this Test? 80

    8.5 Time Estimate to Perform Test 81

    8.6 Procedural Tips and Troubleshooting 81

    8.7 Interpreting Test Results 82

    8.8 Clinical Case Example(s) 82

    8.9 Add-On Tests That You May Need to Consider and Their Additive Value 82

    8.10 Key Takeaways 83

    9 Whole Blood Lactate 84
    Sharon M. Dial

    9.1 Procedural Definition: What Is This Test About? 84

    9.2 Procedural Purpose: Why Should I Perform This Test? 84

    9.3 Equipment 85

    9.4 Procedural Steps: How Do I Perform This Test? 85

    9.5 A Note on Quality Control 85

    9.6 Procedure for Patient Samples 85

    9.7 Time Estimate to Perform Test 87

    9.8 Procedural Tips and Troubleshooting 87

    9.9 Interpreting Test Results 87

    9.10 Clinical Case Example(s) 88

    9.11 Add-On Tests That You May Need to Consider and Their Additive Value 88

    9.12 Key Takeaways 88

    References 88

    10 Saline Agglutination Test 89
    Sharon M. Dial

    10.1 Procedural Definition: What Is This Test About? 89

    10.2 Procedural Purpose: Why Should I Perform This Test? 89

    10.3 Equipment 89

    10.4 Procedural Steps: How Do I Perform This Test? 89

    10.5 Time Estimate to Perform Test 91

    10.6 Procedural Tips and Troubleshooting 91

    10.7 Interpreting Test Results 92

    10.8 Clinical Case Example(s) 92

    10.9 Add-On Tests That You May Need to Consider and Their Additive Value 92

    10.10 Key Takeaways 92

    Reference 93

    11 Activated Clotting Time 94
    Sharon M. Dial

    11.1 Procedural Definition: (“What Is This Test About?”) 94

    11.2 Procedural Purpose: Why Should I Perform This Test? 94

    11.3 Equipment 94

    11.4 Procedural Steps: How Do I Perform This Test? 94

    11.5 Time Estimate To Perform Test 96

    11.6 Procedural Tips and Troubleshooting 97

    11.7 Interpreting Test Results 97

    11.8 Clinical Case Example(s) 97

    11.9 Add-On Tests That You May Need to Consider and Their Additive Value 97

    11.10 Key Takeaways 97

    Part 3 Quick Assessment Tests (QATS) Involving Urine 99

    12 Assessing Urine’s Physical Properties 101
    Ryane E. Englar

    12.1 Procedural Definition: What Is This Test About? 101

    12.2 Procedural Purpose: Why Should I Perform This Test? 101

    12.3 Equipment 102

    12.4 Procedural Steps 103

    12.5 Time Estimate to Perform Test 105

    12.6 Procedural Tips and Troubleshooting 105

    12.7 Interpreting Test Results 106

    12.8 Clinical Case Example(s) 111

    12.9 Add-On Tests That You May Need to Consider and Their Additive Value 113

    12.10 Key Takeaways 113

    12.11 Clinical Pearls 114

    References 115

    13 Urine Specific Gravity 116
    Ryane E. Englar

    13.1 Procedural Definition: What Is This Test About? 116

    13.2 Procedural Purpose: Why Should I Perform this Test? 117

    13.3 Equipment 117

    13.4 Procedural Steps 118

    13.5 Time Estimate to Perform Test 124

    13.6 Procedural Tips and Troubleshooting 124

    13.7 Interpreting Test Results 124

    13.8 Clinical Case Example(s) 126

    13.9 Add-On Tests That You May Need to Consider and Their Additive Value 127

    13.10 Key Takeaways 127

    13.11 Clinical Pearls 127

    References 128

    14 Chemical Evaluation of Urine 130
    Ryane E. Englar

    14.1 Procedural Definition: What Is This Test About? 130

    14.2 Procedural Purpose: Why Should I Perform This Test? 132

    14.3 Equipment 132

    14.4 Procedural Steps 132

    14.5 Time Estimate to Perform Test 136

    14.6 Procedural Tips and Troubleshooting 136

    14.7 Interpreting Test Results 138

    14.8 Clinical Case Example(s) 141

    14.9 Add-On Tests That You May Need to Consider and Their Additive Value 142

    14.10 Key Takeaways 143

    14.11 Clinical Pearls 144

    References 145

    15 Urine Sediment Examination 146
    Sharon M. Dial

    15.1 Procedural Definition: What Is This Test About? 146

    15.2 Procedural Purpose: Why Should I Perform This Test? 146

    15.3 Equipment 147

    15.4 Procedural Steps: How Do I Perform This Test? 147

    15.5 Time Estimate to Perform Test 149

    15.6 Procedural Tips and Troubleshooting 151

    15.7 Interpreting Test Results 152

    15.8 Clinical Case Example(s) 157

    15.9 Add-On Tests That You May Need to Consider and Their Additive Value 157

    15.10 Key Takeaways 157

    Reference 157

    Suggested Bench-Side References 158

    Part 4 Quick Assessment Tests (QATS) Involving Feces 159

    16 Assessing the Physical Properties of Fecal Matter 161
    Ryane E. Englar

    16.1 Procedural Definition: What Is This Test About? 161

    16.2 Procedural Purpose: Why Should I Perform This Test? 161

    16.3 Equipment 164

    16.4 Procedural Steps 166

    16.5 Time Estimate to Perform Test 166

    16.6 Procedural Tips and Troubleshooting 166

    16.7 Interpreting Test Results 172

    16.8 Clinical Case Example(s) 183

    16.9 Add-On Tests That You May Need to Consider and Their Additive Value 183

    16.10 Key Takeaways 185

    16.11 Clinical Pearls 186

    References 187

    17 Direct Smears 191
    Ryane E. Englar

    17.1 Procedural Definition: What Is This Test About? 191

    17.2 Procedural Purpose: Why Should I Perform This Test? 191

    17.3 Equipment 194

    17.4 Procedural Steps [1–5, 20, 30, 60–62] 194

    17.5 Time Estimate to Perform Test 196

    17.6 Procedural Tips and Troubleshooting 196

    17.7 Interpreting Test Results 197

    17.8 Clinical Case Example(s) 198

    17.9 Add-On Tests That You May Need to Consider and Their Additive Value 201

    17.10 Key Takeaways 203

    17.11 Clinical Pearls 204

    References 204

    18 Fecal Flotation 207
    Ryane E. Englar and Jeremy Bessett

    18.1 Procedural Definition: What is This Test About? 207

    18.2 Procedural Purpose: Why Should I Perform This Test? 210

    18.3 Options Available for Fecal Flotation 211

    18.4 Equipment 213

    18.5 Procedural Steps: Fecal Flotation with Fixed-Angle

    Centrifuge [1–4, 8, 11, 22, 23, 28] 213

    18.6 Time Estimate to Perform Fecal Flotation with Fixed-Angle Centrifuge 216

    18.7 Brief Consideration of the Procedural Steps in the Event a Swinging Bucket Centrifuge Is Used 217

    18.8 Equipment 217

    18.9 Procedural Steps 217

    18.10 Time Estimate to Perform Passive Fecal Flotation 221

    18.11 Procedural Tips and Troubleshooting for Fecal Flotation 221

    18.12 Interpreting Test Results 221

    18.13 Clinical Case Example(s) 227

    18.14 Add-On Tests That You May Need to Consider and Their Additive Value 227

    18.15 Key Takeaways 229

    18.16 Clinical Pearls 229

    References 230

    Part 5 Quick Assessment of Body Cavity Fluids 235

    19 Body Cavity Fluid Analysis 237
    Sharon M. Dial

    19.1 Procedural Definition: What Is This Test About? 237

    19.2 Procedural Purpose: Why Should I Perform This Test? 237

    19.3 Equipment 238

    19.4 Procedural Steps: How Do I Perform This Test? 238

    19.5 Time Estimate to Perform Test 240

    19.6 Procedural Tips and Troubleshooting 240

    19.7 Interpreting Test Results 241

    19.8 Clinical Case Example(s) 244

    19.9 Add-On Tests That You May Need to Consider and Their Additive Value 244

    19.10 Key Takeaways 245

    References 245

    Suggested Bench-Side References 245

    Part 6 Clinical Cases 247

    20 Clinical Cases 249
    Jeremy Bessett, with support from Sharon M. Dial

    Case 1: Fred 249

    Case 2: Bella 253

    Case 3: Benji 258

    Case 4: Mittens 266

    Case 5: Star 272

    Case 6: Earl 277

    Case 7: Sammy 281

    Case 8: Coffee 286

    Case 9: Dexter 291

    Case 10: Tabitha 297

    Case 11: Ace 301

    Case 12: Timothy 304

    Case 13: Duckie 307

    Case 14: Angel 311

    Case 15: Chase 314

    Index 321

  • Ryane E. Englar, DVM, DABVP (Canine and Feline Practice)

    Is Executive Director of Clinical and Professional Skills and Associate Professor at the University of Arizona College of Veterinary Medicine in Oro Valley, Arizona, USA.

    Sharon M. Dial, DVM, Ph.D., DACVP (Clinical and Anatomic Pathology)

    Is Research Scientist at the University of Arizona College of Veterinary Medicine in Oro Valley, Arizona, USA.

Veterinary Clinics of North America
info