OCTOBER 2007 A NEWSLETTER FOR THE VETERINARY COMMUNITY OCTOBER HIGHLIGHTS Case Study: Myiasis and Uterine Adenocarcinoma The rabbit was found to be febrile, depressed, approximately 5 percent dehydrated T4 Clinical Evaluation: Abaxis Total T4 Rotor An accurate and reliable inoffice T4 has many potential uses for the general practice Authorized Distributors Conference Calendar About Abaxis Contact Us Don t Miss A Single Issue Of VetCom! Subscribe Today at www.abaxis.com! 888-9300-REV K WELCOME Welcome to the Abaxis VetCom, a newsletter for the Veterinary Community around the world. According to recent statistics, 69 million U.S. households own a pet. Approximately 40 billion will be spent on pets during 2007. Nearly 10 billion is devoted to veterinary care of pets, exotic animals and livestock. Almost 30,000 veterinary clinics provide service to animal owners in the U.S. Approximately 7,000 veterinary clinics, 23% of the U.S. market, have purchased and are using VetScan systems. As you know, our existing VetScan product line, consists of the VetScan Classic Chemistry Analyzer, the VetScan VS2 next-generation Chemistry Analyzer, and the VetScan HM2, Hematology Analyzer. We are pleased to announce, our newest edition, the VetScan HM5, the all new, state-ofthe-art Hematology Analyzer, a 5-part differential at the touch of a button, it's as easy as 1-2-3. The VetScan HM5 is a fully automated 5-part cell counter specifically designed for veterinary applications offering a comprehensive 22-parameter complete blood count with cellular histograms in just minutes. Its superior performance, elegant design, ease of use, true database management capability, and minimal maintenance make it the best hematology system for veterinary clinics, research laboratories, and pharmaceutical/biotech companies. This issue features an opportunity to submit a case study and win your choice of a free upgrade on your existing Abaxis equipment. Upgrade options include: HMT to an HM2, HM2 to the all new HM5, or VetScan Classic to the new VetScan VS2. See page 8 details! Valerie Goodwin Director, Marketing Veterinary Medicine valeriegoodwin@abaxis.com (510) 675-6604 ABOUT ABAXIS, INC. Abaxis is a leader in the development and commercialization of leading-edge innovative technology, tools and services that support best medical practices, enabling practitioners to respond to the health needs of their patients, while operating economical and profitable practices, at the point of care. Abaxis develops, manufactures and markets portable blood analysis systems for use in any veterinary or human patient care setting to provide clinicians with rapid blood constituent measurements. The system consists of a compact, 6.9-kilogram (10.5 pounds) portable analyzer and a series of single use plastic discs, called reagent rotors, that contain all the chemicals required to perform 23 different assays and 8 different profiles. The veterinary business system, which consists of the VetScan VS2, the next generation chemistry, electrolyte, immunoassay, blood gas analyzer, the VetScan HM2 Hematology instrument, and the VetScan HM5 Hematology instrument, can be operated with minimal training and performs multiple routine tests on whole blood, serum or plasma samples. The system provides test results in minutes with superior precision and accuracy equivalent to a clinical laboratory analyzer. Abaxis, Inc. 3240 Whipple Road Union City, CA 94587 Tel. 800-822-2947 Fax 510-441-6150 www.abaxis.com OCTOBER 2007 1
DISTRIBUTORS CASE STUDY United States AniSol Veterinary Distributor 877-426-4765 American Veterinary Supply (AVSC) 800-869-2510 Associated Medical Supply 480-998-1684 DVM Resources 877-828-1026 Great Western Animal Supply 800-888-7247 Hawaii Mega-Cor, Inc. 800-369-7711 Iowa Veterinary Supply 800-457-0118 Merritt Veterinary Supply 800-845-0411 Miller Veterinary Supply 800-880-1920 Nelson Laboratories 800-203-4268 North East Veterinary Supply Co. (NEVSCO) 866-638-7265 Penn Vet Supply 800-233-0210 TW Medical 888-787-4483 Western Medical Supply 800-242-4415 Canada Associated Vet Purchasing, Co. 604-856-2146 CDMV 450-771-2368 MidWest Drug 204-233-8155 VetNovations 705-726-9995 Vet Purchasing 519-284-1371 Vie et Sante 418-650-7888 Western Drug & Distribution 877-329-9332 MYIASIS AND UTERINE ADENOCARCINOMA IN A RABBIT: CRITICAL CARE PLUS ROTOR BY PETER G. FISHER, DVM, PET CARE VETERINARY HOSPITAL Myiasis article continues on page 3 Submit a case study like this and WIN!! See page 8 for details. A 2.3 kg, five year old, intact female that was housed outdoors was presented with a history of lethargy and a soiled back end with a foul odor. The owners had found the rabbit in this state and brought the rabbit indoors the night before presentation. Upon further questioning it was noted that the rabbit had remained in a hunched position all night, had no interest in food, and had not produced any stools in the past 12 hours. On physical exam the rabbit was found to be febrile (103.3ºF, 39.6ºC), depressed, approximately 5% dehydrated, and had wet, soiled fur over its dorsal lumbar area, ventral inguinal area and perineum. A putrid-smelling odor was apparent and on closer inspection myiasis of house fly larvae was discovered. A clinical workup including a critical care blood chemistry analysis, PCV, urinalysis and abdominal radiographs was recommended. General anesthesia to allow clipping and cleaning of infected skin areas and to initiate therapy was approved by the owner. The rabbit was given 0.4 mg/kg meloxicam (Metacam, Boehringer Ingelheim) SQ for analgesia followed by 0.05 mg/kg medetomidine (Domitor, Pfizer) and 10 mg/kg ketamine ( Ketathesia, Butler Animal Health) IM as a sedative/pre-anesthetic. General anesthesia was induced and maintained using sevoflurane (Sevoflo, Abbott Laboratories) administered via a face mask. Lab samples and radiographs were taken and an IV catheter was placed in the cephalic vein through which Lactated Ringers Solution with 2.5% Dextrose and vitamin B-complex was administered at 10 cc/hour. While waiting for laboratory and radiological results the affected areas of skin infection were clipped and cleaned. Multiple areas of maggot infestation were found with varying degrees of dermal erythema, moist dermatitis/ pyoderma and full thickness skin excoriation with dissecting tracts through subcutaneous tissue resulting in fistulation. Nitenpyram (11.4 mg Capstar, Novartis Animal Health) was mixed with 2 cc water until dissolved and applied to areas of active maggot infestation in order to paralyze the parasites thus aiding in more complete removal. The area of infection was cleansed with a disinfectant scrub followed by 0.9% warmed saline flushes and topical silver sulfadiazine (SSD, PAR Pharmaceutical) antibacterial cream. Enrofloxacin (Baytril, Bayer Animal Health) at 20 mg/kg SQ qd was given for secondary bacterial infection. The medetomidine was reversed with an equal volume atipamezole (Antisedan, Pfizer) IM and the rabbit was placed in an ICU cage. While under anesthesia the abdomen was palpated more carefully and a firm, mid-caudal lobular abdominal mass was identified. Abdominal radiographs supported these findings and showed a fluid dense, tubular, mid-caudal abdominal mass. Due to patient signalment and mass location, a uterine neoplasia was suspected. A free-catch urinalysis (Table 1) along with a PCV and blood chemistry panel (Table 2) using the VetScan VS2 Chemistry Analyzer was run in-house. The rabbit was anemic with a PCV of 23. The critical care chemistry panel showed moderate azotemia, and hypoproteinemia (Table 1). The uri- OCTOBER 2007 2
2007 CONFERENCES CASE STUDY Oct. 5-7 Oct. 9-11 Oct. 10-14 Oct. 11-14 Oct. 14-18 Oct. 20-23 Nov. 1-3 Nov. 9-11 Nov. 10-13 Dec. 2-7 Alaska VMA Sheraton Hotel Anchorage, AK Atlantic Coast Vet Conf. Atlantic City Conv. Ctr. Atlantic City, NJ www.acvc.org Wild West Vet. Conf. Grand Sierra Resort Reno, NV www.wildwestvc.com Wisconsin VMA Marriott Madison West Madison, WI www.wvma.org AALAS Charlotte Conv. Ctr. Charlotte, NC www.aalas.org CVC West San Diego, CA www.thecvc.com North Carolina VMA Sheraton Imperial Hotel Research Triangle Park, NC www.ncvma.org Hawaii VMA Pacific Beach Hotel Oahu, HA www.hawaiivma.com ACVP Savannah Trade & Int l Conv. Ctr. Savannah, GA www.acvp.org AAEP Orlando, FL www.aaep.org Myiasis l article continued nalysis (Table 2) showed evidence of hematuria and a proteinuria both consistent with blood contamination from the suspected uterine cancer. Uterine blood loss, along with possible toxemia associated with the fly strike would explain the anemia and hypoproteinemia. Of interest is the urine ph of 5 indicating probable acidosis as the herbivorous rabbit urine is normally alkaline. In light of the moderate urine specific gravity and azotemia the author was concerned that this rabbit was in renal failure. Toxemia secondary to the myiasis was considered as the underlying cause. In rabbits the most common site for fly strike is the area at the base of the spine, between the tail and the dorsum.(1) This is a very difficult area for rabbits to groom effectively especially if overweight, or suffering from decreased flexibility as the result of spondylosis or arthritis.(1) Vaginal bleeding and subsequent perineal soiling are both commonly associated with rabbit uterine cancer and were suspected as the underlying predisposition to this rabbit s maggot infestation as healthy rabbits are not ordinarily affected by fly strike. Uterine adenocarcinoma is the most common neoplasia of female rabbits.(2) With age the uterus undergoes progressive endometrial changes, a decrease in cellularity, and an increase in collagen content all of which have been associated with uterine cancer.(2) The immediate blood analysis indicating azotemia influenced the decision to initiate more aggressive fluid therapy and the rabbit was hospitalized for several days. Meloxicam was discontinued due to potential for NSAIDS to worsen renal disease and the analgesic buprenorphine (Buprenorphine Hydrochloride Injection, Hospira, Inc.) was substituted at 0.05mg/kg SQ q12h. Fluid therapy was maintained at maintenance plus 10% over two days at which time the rabbit was clinically much improved and began to chew multiple IV lines. The rabbit began to eat and pass stools on the second day of hospitalization and the concern for secondary gastrointestinal stasis was diminished. The rabbit was sent home with oral enrofloxacin and topical antibacterials and owners were instructed to recheck in five days to re-assess overall condition and renal values. Client education on the need for proper nutrition, medical care and future abdominal surgery for assessment of the mass and potential ovariohysterectomy were discussed. On the medical progress exam the rabbit had an excellent appetite and was clinically doing well. A Critical Care Plus panel was run on the Abaxis VetScan VS2 Chemistry Analyzer while the owner waited less than 12 minutes for results so that we could discuss long term prognosis and whether surgery to explore the abdomen was an option (Table 1). At this time the azotemia had resolved. The skin was healing and full thickness wounds contracting. There was no change in the abdominal mass on palpation and abdominal surgery was recommended. Chemistry results indicated a return to normal renal function and surgery was scheduled for the following week in order to give the skin more time to heal. CRITICAL CARE PLUS THE ELECTROLYTE ROTOR 8 tests per rotor This rotor provides the following parameters: ALT, BUN, CL, CRE, GLU, K+, NA+, tco 2. Myiasis article continues on page 4 OCTOBER 2007 3
PRODUCT ANNOUNCEMENT CASE STUDY The all-new VetScan HM5. It s accurate. ac cu rate (ak yər ət) adj. it s careful and exact; it s correct; without mistakes or errors; it s the truth, the whole truth and nothing but the truth; it s reference lab quality; it s the skinny, the story, the fine print, the real deal; it s 5-part differential with unquestionable integrity; it s the difference between cold, hard facts and just plain wrong; it s a true representation; it s on the money, on the spot, right on target; it s the difference between a confident diagnosis and an educated guess. IT S VERSATILE! Myiasis article continued Seven days later the skin infection had continued to improve and the rabbit was taken to surgery. A markedly dilated uterus with multifocal firm nodules was found and an ovariohysterectomy was performed. Tissues were submitted for histopathology on which a diagnosis of the suspected uterine adenocarcinoma was confirmed. There was no evidence of gross metastasis at the time of surgery and there was no evidence of neoplastic serosal implantation on histopathology. Recovery from surgery was uneventful and the long term prognosis hopeful. Table 1. Chemistry na = not available DAY 1 DAY 7 Rabbit Reference Ranges for Common Analytes* ALP 29 na 18-128 U/L ALT 85 42 20-109 U/L BUN 81 25 10-32 mg/dl CRE 3.3 1.1 0.5-1.6 mg/dl GLU 138 144 100-155 mg/dl TP 5.3 na 5.3-8.5 g/dl NA na 143 134-149 mmol/l K na 4.8 3.5-6.2 mmol/l * University of Pennsylvania, Philadelphia, PA * For more detailed information on the rabbit reference ranges, please go to: www.abaxis.com/support/technical_briefs.html Table 2. Urinalysis from case report Specific Gravity Protein (mg/dl) ph blood 1.022 30 5.0 positive The all-new VetScan HM5. You can count on it. Sediment: 0-3 RBC, 0-2 epithelial cells per HPF, occ calcium carbonate crystals Normal rabbit urinalysis results* Specific Gravity Protein (mg/dl) ph Urine Volume (ml/24hr) 1.003 1.036 trace 8.2 8.8 130kg *Data from: Benson KG, Paul-Murphy J. Clinical pathology of the domestic rabbit. In: Reavill DR (ed) Veterinary Clinics of North America, Exotic Animal Practice 1999. p 539-551. 1) Harcourt-Brown F. Skin diseases. In: Harcourt-Brown F. (editor), Textbook of Rabbit Medicine. Butterworth Heinemann, London, 2002; 224-248. 2) Pare JA, Paul-Murphy J. Disorders of the reproductive and urinary systems. In: Quesenberry KA, Carpenter JW (editors) Ferrets, Rabbits and Rodents, Clinical Medicine and Surgery, 2nd edition. Saunders, Elsevier 2005; 183-193. OCTOBER 2007 4
CONTACT ABAXIS, INC. T4 CLINICAL EVALUATION 1-800-822-2947 VetCom Issues Valerie Goodwin VetCom, EDITOR Director Veterinary Marketing 510-675-6604 valeriegoodwin@abaxis.com questions and comments Technical Support Craig Darien, ext. 1521 Supervisor, Technical Support North American Sales Randy Knick, ext. 1509 Central Area Sales Director randyknick@abaxis.com Bill Wilson, ext. 1455 Mid-Atlantic Area Sales Director billwilson@abaxis.com Andy Koupas, ext. 1424 Western Area Sales Director andykoupas@abaxis.com John Therrien, ext 1476 Area Sales Manager, Mid-West johntherrien@abaxis.com Gerard Cabrera, ext. 1448 Area Sales Manager, Northeast gerardcabrera@abaxis.com Chris Ballinger, ext. 1492 Area Sales Manager, Southeast chrisballinger@abaxis.com Customer Service Gay Skubec, ext. 6578 Supervisor, Customer Service TWO CLINICAL AND LABORATORY EVALUATIONS OF THE ABAXIS VETSCAN VS2 TOTAL T4 BY DR. CRAIG TOCKMAN AND DALE HOAG An accurate and reliable in-office T4 has many potential uses for the general practice. Many practices use the Total T4 to diagnose feline hyperthyroid disease, screen canine patients suspected of being hypothyroid and routinely screen both dogs and cats as part of an in-house wellness program. Perhaps the most common use is in monitoring response to therapy for both hyperthyroid and hypothyroid patients. The Abaxis VetScan VS2 Total T4 assay has been correlated to the method utilized at Michigan State University and the internal quality controls of the VetScan VS2 provide veterinarians with accurate and reliable results. Some clinicians choose to compare the T4 results obtained on the VetScan VS2 with a commercial laboratory for individual cases. In an attempt to recreate this scenario under controlled conditions, a set of 7 known T4 controls was run in duplicate on both a VetScan VS2 at a private veterinary practice and at a major commercial laboratory that performs T4 RIA. Reference ranges are listed as 1.1-4.0 for the VetScan VS2 and 1.0-4.4 for the commercial lab. The results are shown in the table below: Table 1. Control VS2 VS2 Commercial Commercial P1 1.70 1.1 1.1 1.68 0.88 P2 3.93 3.3 3.3 3.19 2.54 P2 4.82 4.0 4.4 3.19 3.04 P4 5.76 4.7 4.8 3.63 4.14 P5 6.55 6.0 6.0 5.59 5.62 P6 7.19 6.6 6.8 5.07 5.20 P7 9.20 8.4 8.5 6.20 6.22 From a clinical perspective, results that would have provided accurate diagnostic information or medication titration information are highlighted in green. The results that would have potentially led to an inaccurate diagnosis or an inaccurate medication titration are highlighted in red. Yellow highlights indicate accurate potential diagnostics, but borderline reliability when titrating or monitoring medication. The run highlighted in blue is a borderline value, and interpretation would depend on species and presentation. The two runs for each analyzer were averaged and placed on a chart to look at the same data shown above, visually. T4 Case Study continues on page 6 OCTOBER 2007 5
CUSTOMER SAMPLING T4 CLINICAL EVALUATION MEDICAL & RESEARCH T4 Case Study continued T4 Chart. VetScan VS2 Avg. UNIVERSITIES A statistical analysis was also performed and showed the following: R2 Slope VetScan VS2 0.99 0.99 Commercial 0.94 0.70 This study shows several important things: 1. When evaluating the accuracy of a test in a clinical setting, it is important to run the study in a double blind fashion. This is accomplished either by obtaining a third value from another lab, or preferably by comparing to a known set of controls as performed here. 2. The value from the commercial lab may not be correct. This is clearly evident from the T4 values obtained in this study. Commercial labs are subject to the same requirements and variability relative to their use of quality controls, sample quality, etc. And, it is important that the clinician remember to account for clinical signs as part of any evaluation. If you must run comparison samples or run confirmation tests, a reference laboratory such as Michigan State University would be preferable. VETERINARY FACILITIES 3. Different analyzers - especially those using different methodologies - can produce different results and both of those results may be accurate or inaccurate. This makes comparison of values such as a Total T4 by two different methods a poor comparison in the clinical setting. Because of this, it is vital that the reference range for the particular analyzer be the guiding factor in determination of the clinical relevance of the result, not a comparison to another method. Another study was recently performed at a major U.S. Veterinary Teaching Hospital.* Duplicate VetScan VS2 runs were compared to a single value obtained on the Hitachi 912 instrument at the laboratory and included ill patients presented to the University. Table 1 provides the results of this study. The graphic description of the study is also provided. T4 Case Study continues on page 7 OCTOBER 2007 6
EDITORIAL STAFF Valerie Goodwin Director, Marketing Veterinary Medicine VetCom Editor 510-675-6604 valeriegoodwin@abaxis.com Craig M. Tockman, DVM Director of Professional Services, Abaxis, Inc. Veterinary Care Center, St. Louis, MO 800-822-2947, ext. 1422 craigtockman@abaxis.com T4 CLINICAL EVALUATION T4 Case Study continued # Samples 68 R 2 0.92 Slope 1.15 Y Intercept 0.07 Total T4. Baerbel Koehler Abaxis Sales and Marketing Manager for Europe, Africa and the Middle East Darmstadt, Germany +49 6151 350 79 0 baerbelkoehler@abaxis.de Kent Adams, DVM Abaxis Advisory Board Member Equine/Large Animal Practitioner kentadams@abaxis.com Don J. Harris, DVM Abaxis Advisory Board Member Avian/Exotic Practitioner donharris@abaxis.com In all cases, the VetScan VS2 shows excellent correlation (R>0.90) for total T4 with the University reference method. Four of 24 (16.7%) feline cases were discordant for Total T4 with the University reference method. Two were within the reference interval on the VetScan with low values on the Hitachi, 1 was slightly low on the VetScan with a value within the reference interval on the Hitachi, and one was normal on the VetScan with a slightly decreased value on the Hitachi. In each case, the discordant value was for a below normal Total T4. As these were clinically ill patients, a diagnosis of sick euthyroid syndrome would likely have been made rather than a diagnosis of feline hypothyroid disease. Seven of 44 (15.9%) canine cases had discordant values. Five were low on the VetScan VS2 with values within the reference interval on the Hitachi, one was within the reference interval on the VetScan VS2 with a slightly low value on the Hitachi, and one was high on the VetScan VS2 with a value within the reference interval on the Hitachi. Six cases had a discordant value that was for a below normal Total T4. Of those dogs, four had other laboratory evidence of significant disease that could cause a sick euthyroid state and would not have affected interpretation. One dog had only a mild decrease in total T4, which may have been normal for that patient. Two dogs (one with no other significant laboratory abnormalities and the one with the high value) would likely have undergone further testing for thyroid disease. These studies show that the VetScan VS2 total T4 test performs extremely well and shows excellent correlation to a University reference method. It can accurately diagnose feline hyperthyroid disease, and performs extremely well in the monitoring and titration of thyroid medications and in screening for hypothyroid disease in dogs. *Clinical Evaluation done at University California - Davis Medical Veterinary Teaching Hospital. OCTOBER 2007 7
ROTOR PROFILE Win A Free Upgrade! SUBMIT A CASE STUDY AND WIN! If you have a case study that includes how your in-clinic laboratory system has made a difference, and your case study is published in VetCom - you can WIN! WHAT YOU WILL WIN! You will be given a choice of a Free Upgrade! Mammalian Liver Profile (MLP) Ideal for obtaining baseline values prior to administration of NSAIDs and monitoring liver function concurrent with their use. Designed also to aid both in the diagnosis of and monitoring the progression of hepatic disease. Screen and monitor patients while receiving chronic therapy. - NSAIDs. - Any medication detoxified in the liver. - Monitor renal function in the non-dehydrated patient. Monitor patients with chronic liver disease. - Complete panel of hepatic enzymes and related analytes to monitor hepatic function. Diagnose liver disease utilizing hepatic enzymes, related analytes and bile acids. Bile acids elevate due to: - Decreased Bile Acid clearance from portal blood. o Hepatocyte damage reduces functional hepatic mass causing impaired clearance. o Congenital and acquired porto-systemic shunts. - Decreased biliary excretion of Bile Acids. o Impaired hepatic or post-hepatic bile flow due to any cause. You Choose: a. HMT to an HM2 b. HM2 to the all new HM5 c. VetScan Classic to VS2 HOW TO ENTER! Send your case studies to Valerie Goodwin. E-mail: valeriegoodwin@abaxis.com Mail: Valerie Goodwin Marketing Director, Veterinary Medicine Abaxis, Inc. 3240 Whipple Road Union City, CA 94587 (Open to owners and principals of veterinary practices, research facilities, academic environments, and pharmaceutical/biotech companies. Instrument being upgraded must be returned to Abaxis.) OCTOBER 2007 8
STATE-OF-THE-ART HEMATOLOGY 5-PART DIFFERENTIAL AT THE TOUCH OF A BUTTON NEW! VetScan HM5, a fully-automated 5-part cell counter specifically designed for veterinary applications, offers a comprehensive 22-parameter complete blood count with cellular histograms in just minutes. Its superior performance, elegant design, ease of use, true database management capability, and minimal maintenance make it the only hematology system for veterinary clinics, research laboratories, and pharmaceutical/biotech companies. FEATURES 50 μl sample size 5-part differential on Cat, Dog, Horse Seven other species available in 3-part differential mode Small, space-saving, and elegant design with large LCD display Pre-dilute mode available for challenging samples Simple, intuitive, and easy to navigate software interface 22 parameters, including eosinophil counts and eosinophil percentage Advanced and integrated self-cleaning system Large database storage capacity, simplicity, flexibility, and usability CD drive and USB ports Integrates to the VetScan and data management systems User-reminder functions Multi-user mode BENEFITS 10 species available now Small footprint Easy to use Reliable results, including out of range values Rapid test turn-around with minimal hands-on time Customizable reference ranges Superb performance with minimal maintenance Automatically saves up to 2000 test records. All downloadable through USB pen drive and integrated data management system Allows for software updates and future instrument upgrades Integrated result reporting and comprehensive laboratory analysis Software tracks reagent usage and notifies user to replace reagents when necessary Eco-friendly reagents THREE EASY STEPS Seconds of hands-on time is needed for performing CBC measurements using the VetScan HM5. All you need to do is 1) enter patient information, 2) insert a well-mixed blood sample and press start, 3) read results. The test results and four cellular histograms will be displayed in minutes. enter information insert sample and press start read results
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