To differentiate between pituitary-dependent hyperadrenocorticism and adrenal-dependenthyperadrenocorticism in a dog confirmed to have hyperadrenocorticism (by LDDST or ACTH stimulationtest).
- Collect blood into a plastic EDTA tube, ensuring that the tube is filled to the line. Gently mix by inversion.
- Centrifuge the sample immediately.
- Transfer the plasma into a plain plastic tube (no additive) and freeze immediately
- Samples must be sent frozen and should still be frozen upon arrival at the laboratory. If dry ice transport is not available, the tube should be carefully sealed and then frozen into a large block of ice, ensuring that there is sufficient ice to keep the plasma sample frozen during transport.
- Note the collection date and time on the submission form.
- ACTH is a very labile protein. Suboptimal specimen collection and handling may result in a falselylow measured ACTH concentration.
- If a centrifuge is not available, EDTA whole blood should be chilled immediately and sent to arrive atthe lab as soon as possible (preferably within one hour).
- Markedly lipaemic and/or haemolysed samples may yield false results and samples should beredrawn prior to submission.
Sample required:
Serum (0.5 mL) or Clotted blood (1.5 mL)
Blood tube required:
Gel (gold top) or plain (red top).
Test use:
- To diagnose hypoadrenocorticism (Addison’s disease) and iatrogenic hyperadrenocorticism in dogs.
- To assist in the diagnosis of hyperadrenocorticism in dogs.
- To monitor response to therapy for hyperadrenocorticism.
Protocol:
- If glucocorticoids have been administered recently, refer to Notes below.
- If testing for hyperadrenocorticism, maintain the dog in a stress free environment.
- In the morning, collect a resting blood sample and label it “0 h”.
- Administer synthetic ACTH (e.g. Synacthen® Novartis) (non-depot formulation) at 250 ug/dog IM or 5 ug/kg IV or IM.For depot formulation of Synacthen, use 250 ug/dog IM.
- Collect a 1-hour post-ACTH blood sample and label it “1 h”.
- Store samples at 4°C and submit both samples together to the laboratory. If transport to the laboratory will be delayed (> 12 hours), the sample should be centrifuged and the serum separated.
- On the laboratory submission form, list samples and collection intervals, note the reason for testing and note any recent corticosteroid therapy.
Following medical therapy for hyperadrenocorticism an ACTH stimulation test should be performed:
Trilostane
- 10 days, 4 weeks, 12 weeks and then every 3 months following initiation of trilostane therapy and following dose adjustments.
- Perform the test 4-6 hours after administration of trilostane.
Mitotane
- 48 hours after the last loading dose OR 8-9 days after commencing therapy.
- Once maintenance therapy has commenced, recheck every 2-6 months.
- Specific testing for hyperadrenocorticism should not be performed in unwell or significantly stressed animals, whichmay yield false positive results in adrenal function tests. In potentially hyperadrenocorticoid dogs with significantintercurrent disease such as diabetic ketoacidosis or pancreatitis, adrenal function testing should be delayed untilintercurrent disease is controlled.
- Specific testing for hypoadrenocorticism (Addison’s disease) may be done in unwell/stressed animals.
- Anticonvulsant therapy (phenobarbital, primidone, phenytoin) may cause an elevated post-ACTH cortisolconcentration.
- Any form of corticosteroid therapy may interfere with adrenal function tests, by (a) cross-reacting in the cortisol assay(except for dexamethasone), or (b) affecting the pituitary/adrenal axis via suppression of ACTH production. As a guide,the minimum periods for which corticosteroid therapy should be withheld before an ACTH stimulation test are:Injectable (short acting) 7 days (48 h if dexamethasone, except in a potential Addisonian dog, see below)
- - Oral 2 weeks
- - Topical 2 weeks
- - Injectable (depot) 2 months
- If glucocorticoid therapy is required for immediate management of a potential Addisonian dog, a singledexamethasone dose should be used as this will not interfere with the ACTH stimulation test.
- To assist in the diagnosis of hyperadrenocorticism and iatrogenic hyperadrenocorticism.
- Hypoadrenocorticism (Addison’s disease) is extremely rare in cats; an ACTH stimulation test should only be considered when all other potential causes for the illness being investigated have been excluded.
- If glucocorticoids have been administered recently, refer to Notes below.
- Maintain the cat in a stress free environment.
- In the morning, collect a resting blood sample and label it “0 h”.
- Administer synthetic ACTH (e.g. Synacthen®Novartis) (non-depot formulation) at 125 ug/cat IM orIV.
- Collect a 30 minute post-ACTH blood sample and label it ’30 mins’.
- Collect a 60 minute post-ACTH blood sample and label it ‘60 mins’.
- Store samples at 4°C and submit both samples together to the laboratory. If transport to the laboratory will be delayed (> 12 hours), the sample should be centrifuged and the serum separated.
- On the laboratory submission form, list samples and collection intervals, note the reason for testing and note any recent corticosteroid therapy.
- In cats, sensitivity of the ACTH stimulation test for diagnosis of hyperadrenocorticism is poor (estimatesvary from 30 – 50%). A low dose dexamethasone suppression test or the urine cortisol:creatinine ratioscreening test may be preferred.
- Specific testing for hyperadrenocorticism should not be performed in unwell or significantly stressedanimals, which may yield false positive results in adrenal function tests. In potentiallyhyperadrenocorticoid cats with significant intercurrent disease such as diabetic ketoacidosis orpancreatitis, adrenal function testing should be delayed until intercurrent disease is controlled.
- Any form of corticosteroid therapy may interfere with adrenal function tests, by (a) cross-reacting in thecortisol assay (except for dexamethasone), or (b) affecting the pituitary/adrenal axis via suppression ofACTH production. As a guide, the minimum periods for which corticosteroid therapy should be withheldbefore an ACTH stimulation test are:
- - Injectable (short acting) 7 days (48 h if dexamethasone)
- - Oral 2 weeksTopical 2 weeks
- - Injectable (depot) 2 months
Sample required:
EDTA plasma (0.5 mL minimum) or serum ifcentrifuged and separated shortly afterclotting
Blood tube required:
EDTA plasma in a plain (non-additive) tube, orserum in a plain tube
For the diagnosis of aldosterone secreting tumours in cats, and less commonly in dogs. These animals are often (but not always) persistently hypokalaemic and are often hypertensive.
EDTA plasma
- Collect blood into a plastic EDTA tube, ensuring that the tube is filled to the line. Gently mix by inversion.
- Centrifuge the sample immediately.
- Transfer the plasma into a labelled plain plastic tube (no additive) and freeze immediately.
- Samples must be sent frozen and should still be frozen upon arrival at the laboratory. Contact the laboratory to arrange a dry ice collection. If dry ice transport is not available, the tube should be carefully sealed and then frozen into a large block of ice, ensuring that there is sufficient ice to keep the plasma sample frozen during transport.
- If a centrifuge is not available, EDTA whole blood should be chilled immediately and sent to arrive at the lab as soon as possible (preferably within one hour).
- Note the collection date and time on the submission form.
Serum
- Serum is an acceptable alternative sample if it has been centrifuged and separated within 30minutes of clotting.
- The sample should be frozen and should still be frozen upon arrival at the laboratory. Contact the laboratory to arrange a dry ice collection. If dry ice transport is not available, the tube should be carefully sealed and then frozen into a large block of ice, ensuring that there is sufficient ice to keep the plasma sample frozen during transport.
- Note the collection date and time on the submission form.
Sample required:
Clotted blood (3.0 mL)
Blood tube required:
Plain (red top) tube
Anti--Müllerian Hormone is a hormone involved in gender differentiation in the developing embryo. Insexually mature animals it is produced by the granulosa cells of ovarian follicles and the Sertoli cells of the testicles.
AMH levels markedly decline following neutering.
- For distinguishing between spayed and intact female dogs, cats and rabbits. This test may also detect females with ovarian remnant syndrome in an animal that was previously spayed.
- For distinguishing between castrated and intact male dogs, cats and rabbits. This test may also detectcryptorchid males.
- The sample should be collected early in the week to ensure that it is received at the laboratory byWednesday.
- A fasted sample is preferred to avoid lipaemia.
- Collect 3 mL of blood into a plain (red top) tube.
- Allow the sample to clot for 30 minutes at room temperature, and then refrigerate until courier collection
- Samples should reach the lab within 2 days of collection as AMH concentrations gradually increase withsample aging due to dissocation of AMH dimers.
- The test is only suitable for sexually mature animals (typically over 6 months of age). Repeat testing maybe needed for animals between 6-12 months.
- Testing should be delayed for at least 30 days after spaying/neutering to allow for residual AMHconcentrations to decline.
- Negative AMH test results do not rule out the possibility of ovarian remnant syndrome orresidual/retained testicular tissue. If clinical signs are consistent with presence of an ovarian remnant orresidual/retained testicular tissue but AMH concentrations do not support this, progesterone testing(females) or testosterone testing (males) should be considered. GnRH/hCG stimulation testing may berequired in some cases.
Sample required:
Serum or Plasma (0.5 mL)Whole Blood (1.5ml)
Blood tube required:
Gel (gold top) or plain (red top) tubes. LithiumHeparin (Green top) or EDTA (purple top) may also be used.
Test Use
Bile acids are produced in the liver, secreted into the biliary system and subsequently into the duodenum where they aid in digestion of fats. They are then reabsorbed and removed from the portal circulation by the liver for reuse.
Measured blood bile acids will be influenced by any process that affects any part of this recycling system. This may include biliary obstruction, reduced hepatic mass, loss of function with acute inflammatory or toxic insults, or when portal blood is shunted away from the liver.
- The animal should be fasted for 12 hours.
- Collect a fasting blood sample. Clearly label the tube with the patient’s details and ‘0 hr’.
- Feed the dog or cat a small meal to stimulate gall bladder contraction. It is recommended that pets <5kg ofbody weight eat at least two teaspoons of food, those that weigh more eat at least two tablespoons. It isimportant to watch closely to ensure that all of the food is eaten. Avoid overfeeding as this may result insample lipaemia which can interfere with the bile acid assay.
- Collect the post-prandial blood sample 2 hours after feeding. Clearly label the tube with the patients detailsand ‘2 hr’.
- Transport both samples to the laboratory within 12-24 hours of collection.
- Sample lipaemia and haemolysis may interfere with the results of the bile acid assay.
- Bile acid testing is NOT necessary in an animal that is clinically icteric or has hyperbilirubinaemia that is not due to haemolytic disease, since this already indicates impaired liver and/or biliary function.
- Some Maltese terriers have increased bile acid concentrations in the absence of liver disease, therefore it may be impossible to determine the significance of increased bile acid concentrations in this breed.Additional non-invasive diagnostic options include ammonia challenge test and abdominal imaging
Sample required:
EDTA blood (2.0 mL) and serum (2 ml) from the recipient and each donor
Blood tube required:
EDTA (purple top) tubePlain (red top) tube
Test Use
Cross-matching is used prior to a blood transfusion in order to determine if the donor’s blood is compatible with the blood of an intended recipient. An incompatible cross match usually indicates prior sensitisation (and hence antibody formation), except in the cat which has naturally occurring antibodies.
The major cross match tests erythrocytes of the donor against the serum or plasma of the recipient. This allows detection of antibodies in the recipient which will react with donor erythrocytes. Major cross match incompatibilities may result in life-threatening transfusion reactions if that blood is transfused into the recipient.
The minor cross match tests serum or plasma of the donor against erythrocytes of the recipient. This detects the presence of antibody in the donor blood which may react with the recipient erythrocytes. Minor cross-match incompatibilities are usually not life threatening due to marked dilution of the donor antibodies following transfusion.
- Take care to avoid or minimise any haemolysis during sample collection, as this can invalidate results.
- Recipient: Collect 2 mL of blood into an EDTA tube and 2 mL of blood into a plain serum tube
- Donor/s: Collect 2 mL of blood into an EDTA tube and 2 mL of blood into a plain serum tube
- Refrigerate samples until transport to the laboratory
- Ensure EDTA tubes are filled to the correct level (line on tube)
- Agglutination or haemolysis may interfere with results.
Sample required:
- Whole blood in a blood culturemedium bottle
- CSF or joint fluid in a blood culturemedium bottle (using the sameprinciples described below)
- Ideally the blood should be collected prior to antibiotic therapy, as the likelihood of a positive blood culture result is significantly reduced in patients receiving antibiotics.
- Culture of 2-4 blood samples taken during a 24-48 hour period may be necessary to obtain apositive result. If the animal is intermittently febrile, specimens should be collected when the body temperature spikes.
- Blood culture medium bottle:
- Before use, bottles should be stored at 18C to 25C
- Check the expiry date shown on the bottle label.
- Before use, examine the broth for turbidity (which may indicate contamination). Discard if there is any evidence of turbidity.
- The ideal (and maximum) volume of blood to be collected is 4 mL (for the BacT/ALERTPF Plus supplied by ASAP), though smaller volumes of blood can be used. The more blood collected (without overfilling the bottle), the greater the likelihood of bacterial recovery.
- Prepare the site of collection as for a surgical site (70% ethanol should be allowed to act for at least 30 seconds).
- Prepare the blood culture bottle: Remove the plastic flip-off cap and disinfect the exposed partof the rubber stopper (70% ethanol should be allowed to act for at least 30 seconds).
- Collect blood by venipuncture using a strict aseptic technique and sterile equipment.
- Immediately transfer blood to the blood culture bottle: aseptically inject a maximum volume of4 mL of blood through the central ring of the rubber stopper.
- After inoculation of the bottle, disinfect the exposed part of the rubber stopper
- Thoroughly mix the blood with the medium in the bottle.
- Write identification details on the bottle including patient name, specimen and date and time ofinoculation.
- Keep the inoculated blood culture bottle at room temperature. Do NOT refrigerate.
- Transport to the laboratory as soon as possible.
A strict aseptic collection technique is critical. Contaminants from the animal’s skin or other externalsources may give misleading results or mask significant bacteria.
Sample required:
Clotted blood (1.0 mL) orSerum (0.5 mL)
Blood tube required:
Plain or Gel (Red or Gold top) tubes
Clinical Information and Applications
CRP is a major acute phase protein (APP) in canines and forms part of the acute phase inflammatory response. Any inflammatory reaction that cannot be contained locally will “spill over” and initiate a systemic response, resulting in hepatic synthesis and release of CRP into the circulation. In diseases that are predominantly inflammatory in nature, integrated measurement of the severity of inflammation may be superior to measurement of organ specific marker enzymes.
KEY BENEFITS OF C-REACTIVE PROTEIN (CRP) AS “THE SYSTEMIC INFLAMMATORY MARKER” IN DOGS:
- CRP is a specific and objective marker for systemic inflammation. It can identify systemic inflammation when other indicators may be inconclusive e.g. normal body temperature, normal leucogram, or to help differentiate a stress/corticosteroid leucogram from an inflammatory leucogram.
- Not affected by anti-inflammatory doses of corticosteroids, NSAIDs or opioid therapy.
- Real time marker – rises after 4 hrs, peaks at 24 hrs and clears in 48-72 hrs after cessation of an inflammatory stimulus.
- Large diagnostic window – 10 to 1000 fold increase in concentration.
- Quantitative – use CRP to quantify the severity of inflammation, monitor disease burden and progression, monitor post treatment and post-operative inflammation, and to monitor recovery and for potential relapse of disease.
For detection and monitoring of a systemic inflammatory response in dogs.
- A fasted sample is preferred to avoid lipaemia (although not essential).
- Collect blood sample.
- Store the sample at 4°C. If transport to the laboratory will be delayed (> 12 hours), the sample should be centrifuged and the serum separated.
Sample required:
Free catch urine collected into a special preservative container
- 85% of canine transitional cell (urothelial) carcinomas (TCC/UC) carry a mutation in the BRAF gene
- This mutation may be detected in a urine sample containing as few as 10 mutant-bearing cells
- 15% of canine TCC/UC lack BRAF mutation. More than two thirds of these have other genomic signatures detectable by a second level test (BRAF-PLUS). See also Notes below.
- The overall sensitivity to detect canine TCC/UC is therefore > 95%.
- Specificity of both BRAF and BRAF-PLUS tests is ~ 100%.
- The BRAF mutation has not been detected in non-neoplastic bladder lesions, including benign polyps and cystitis
- The test is not impacted by the presence of blood, protein, glucose or bacteria in urine, or by drug therapy (including antibiotics and NSAIDS).
- Any dog with:
- Unexplained bladder wall change on ultrasound examination (especially broad-based mass-like lesion)
- Dogs over 6 years old with:
- Undiagnosed cause of lower urinary tract disease (e.g. haematuria, dysuria, stranguria, pollakiuria,incontinence)
- Non-resolved urinary tract infection after appropriate antibiotic treatment
- As a screening test in high-risk breeds.
- During chemotherapy for TCC/UC to monitor treatment success via decreased levels of BRAF mutation,or to monitor for relapse by detection of BRAF mutation-bearing cells.
- Urine must be collected into a special preservative solution
- To obtain a test kit please call the laboratory and request a CADET® BRAF urine collection kit.
- The test kit consists of:
- Urine sample jar containing preservative- Antech instruction sheet for owner (or veterinarian) regarding collection
- Antech checklist form for veterinarian to complete
- “ASAP BRAF Instructions for Veterinarian” slip stapled to Antech checklist form. These instructions will include what information to write on the Antech checklist form and what to submit to ASAP laboratory.
- The required sample is 40 mL free-catch (voided) urine
- A smaller volume of urine (10-25 mL) may be submitted though the sensitivity may be decreased (this is less likely to be a problem if a bladder mass can be visualised)
- A smaller volume may also limit option of the second level BRAF-PLUS test, if required (see above and below)
- Urine collected by cystocentesis or catheterisation is NOT recommended since the sensitivity may be decreased.
- Urine should first be collected into a clean, dry container and transferred into the preservative within 15minutes of collection
- Once in the preservative, urine is stable for several days at room temperature when kept out of direct sunlight
- Short periods of refrigeration should not affect the specimen but refrigeration is not necessary
- Urine collection may take place over 2-3 days as long as each aliquot is promptly placed into the preservative solution and stored out of direct sunlight.
- ASAP Laboratory prepares cytocentrifuge smears from the submitted urine. These smears are sent to the USA for testing.
- If the submitted sample does not have detectable BRAF mutation, the BRAF-PLUS test for other relevant genomic signatures (see above) will automatically be performed at no additional charge. However, because more DNA is required to perform the BRAF-PLUS assay, a small number of samples that areBRAF-undetected will not be eligible for the BRAF-PLUS assay, and a new urine sample must be submitted (which will incur a second charge).
- When a mass is detected, histologic confirmation of TCC/UC is recommended which may also indicate whether the mass has invaded the muscle wall. Further imaging and evaluation of local lymph nodes should be performed to stage the disease.
- Timing of ovulation of optimal breeding: serial progesterone measurements +/- concurrent vaginal cytology will typically be used to identify the surge in progesterone that accompanies ovulation. Progesterone is low during anoestrus and proestrus, begins to rise in late proestrus, and increases rapidly around ovulation. Levels are high at the beginning of dioestrus.
- Timing of parturition in pregnant dogs: progesterone concentrations fall in the 36-48 hours prior to whelping.
- Determination of pregnancy or pseudopregnancy: Serum progesterone is not useful to confirm pregnancy in dogs, as levels are similar between pregnancy and dioestrus. Progesterone cannot reliably distinguish between pregnancy and pseudopregnancy.
- Diagnosis of ovarian remnant syndrome: If AMH is normal but there is a high index of suspicion for ORS, progesterone may be useful. Serum progesterone levels will not be different between anoestrus and ovariectomized animals, so the animal must in dioestrus or pregnant.
- Plain / red top tube or gel tube, minimum 0.5mL blood.
- Timing of collection for ovulation/mating
- At first signs of heat, obtain baseline progesterone level (or within 1-2 days of detecting >60% cornified cells on vaginal cytology)
- Re-test on day 5-6 of cycle, and continue testing every 2-3 days
- Once progesterone concentrations reach 6 nmol/L, test every 1-2 days
- Ovulation occurs at or around 16 nmol/L
- Breeding schedule is then determined based on method of insemination and type of semen
- The breeding window is typically closed once progesterone concentrations reach 75 nmol/L
- Timing of collection for parturition
- Measure progesterone within 1-2 days of expected parturition date
- Progesterone concentrations fall to <6 nmol/L 36-48 hours before whelping
- Timing of collection for ovarian remnant syndrome
- Measure progesterone 7-10 days after signs suggestive of oestrus
- Progesterone is produced by the post-ovulatory corpus luteum and so non-basal levels indicate ovarian tissue
SAMPLEREQUIRED:
Blood, minimum 1mL
BLOOD TUBE REQUIRED:
EDTA
- For evaluation of blood concentrations of cyclosporine, an immunosuppressant drug used for the treatment immune-mediated disease.
- Cyclosporin concentrations are typically checked 1-2 days following initiation of therapy, and then every 2-4 weeks.
- Blood is collected into an EDTA tube, and kept refrigerated until collection.
- Trough concentration is most commonly measured, as target peak concentrations have not been well established.
- Trough concentration
- Trough samples should be collected approximately 1 hour before the next scheduled dose.
- Peak concentration
- Peak samples should be collected 2 hours after administration.
Results are reported in ng/mL, with general interpretive guidelines for both trough and peak concentrations.
SAMPLE REQUIRED:
Serum (0.5mL)or clotted blood (1.5mL)
BLOOD TUBE REQUIRED:
Gel (gold top) or plain (red top) tube
To assist in the diagnosis of pituitary pars intermedia dysfunction (PPID) (Cushings-like syndrome) in horses.
- Ensure no glucocorticoids have been administered during at least the preceding 48 h (see Notes below).
- Maintain the horse in a stress free environment.
- 5 pm: Collect a resting blood sample and label it “0 h”.
- 5 pm: Administer dexamethasone sodium phosphate at 0.04 mg/kg IM.
- 12 noon: Collect a post-dexamethasone blood sample and label it “19 h”.
- Store samples at 4°C and submit both samples together to the laboratory. If transport to the laboratory will be delayed (> 12 hours), the samples should be centrifuged and the serum separated.
- On the laboratory submission form, list samples and collection intervals.
- The time of day is not critical but serves as a guide. The interval between samples should be 19 to 24 hours.
- Specific testing for hyperadrenocorticism should not be performed in unwell or significantly stressed animals, which may yield false positive results in adrenal function tests.
- Any form of corticosteroid therapy may interfere with adrenal function tests, by (a) cross-reacting in the cortisol assay (except for dexamethasone), or (b) affecting the pituitary/adrenal axis via suppression of ACTH production.
- There is potential for seasonal variation, with an increased risk of false positives in autumn
Sample required:
Serum (0.5 mL) or Clotted blood (1.5 mL)
Blood tube required:
Plain (red top) tube
Monitoring of serum digoxin concentration in dogs and cats being treated for congestive heart failure, atrial fibrillation or flutter, and supraventricular tachycardia.
- Serum digoxin concentration should be assessed 6-7 days after starting therapy or after a change of dose.
- Fasting of the patient is not crucial; however a 12 hour fast (overnight) is recommended to avoid sample lipaemia.
- Collect blood sample within one hour of the next scheduled dose or at least 8 hours after the last dose (trough concentration).
- Store sample at 4°C. If transport to the laboratory will be delayed (> 12 hours), the sampleshould be centrifuged and the serum separated.
Gel/serum separator tubes are not recommended as the gel may absorb some of the drug, artificially lowering the serum concentration.
SAMPLE REQUIRED:
EDTA plasma (preferable) (2 mL) or
EDTA whole blood (4mL)
BLOOD TUBE REQUIRED:
EDTA plasma in a plain (non-additive)tube, or
EDTAwhole blood(purpletop)
Test use:
To aid in the diagnosis of pituitary pars intermedia dysfunction (PPID; equine Cushing’s disease).
- Collect blood into an EDTA tube, ensuring that the tube is filled to the line. Gently mix by inversion.
- Chill the sample within 3 hours of collection.
- Separate the plasma from the red blood cells by centrifugation or by gravity.
- Pipette off the EDTA-anticoagulated plasma into a plain plastic tube (no additive).
- Transport the sample to the laboratory with ice packs (chilled).
- If delays of greater than 48 hours are expected between sample collection and analysis at the lab the plasma sample should be frozen. Do not freeze whole blood.
- Submission of whole blood in EDTA may still provide meaningful results if received by the laboratory within 24-48 hours of collection.
All equine abortions should be treated as infectious.
- Chlamydia psittaci has been documented in cases of equine abortion in Australia and is zoonotic.
- Equine herpes virus 1 (EHV-1) is endemic in Australia and is the most important viral cause of abortion in horses. EHV-1 is also a common cause of respiratory infection in young horses and may cause neurological disease. Most have antibodies to EHV-1 by the time they are two to three years old, and older horses rarely show clinical signs of infection. As with other herpes viruses, horses carry EHV-1 for life and the virus may be reactivated and excreted during times of stress. Abortion usually occurs between 8-11 months of gestation, but it can occur as early as 5 months. Abortion can occur 2 weeks to several months after infection. The aborted foetus, foetal membranes and fluids, and uterine discharges from an affected mare contain large amounts of infective virus. The mare may also remain infective for up to two weeks, shedding virus via the respiratory route. Infected foals may be born weak, and can serve as a source of infection to other healthy foals. The virus can contaminate pasture, feed, bedding and fomites and can also be spread via floats and on the boots and clothing of people. It remains infective in the environment and on horse hair for up to six weeks in cool moist conditions, therefore cleaning and disinfection is critical.
- Equine herpes virus 4 (EHV-4) typically only causes acute respiratory disease in foals greater than two months, weanlings and yearlings. It rarely causes isolated abortions but is not considered an important contagious risk for abortion.
- Use disposable gloves and outerwear which can be properly disinfected. A mask (P2/N95 or higher rating; surgical masks may not be effective) and goggles should be worn to protect the face from splashing fluids.
- Please provide PIC number (property identification code) as well as detailed history on the request form. EHV-1 is a notifiable disease in Victoria.
Sample collection:
Footnotes:
a = preferred sample is single dry swab of multiple sites across the placenta (amnion, umbilical cord between amnion and chorioallantois, chorioallantois near umbilical cord insertion). Alternative sample is fresh tissue (chorioallantois or pool of each of those sites).
b = amnion, umbilical cord between amnion and chorioallantois, chorioallantois near umbilical cord insertion, chorioallantois at cervical pole.
EHV-1 PCR, Chlamydia psittaci PCR
Submit individual tissues in separate sterile leak-proof pots. Label these pots e.g. “Fresh lung – PCR”. Duplicate sets of tissues are not required (i.e. the same piece of each tissue can be tested for both EHV-1 and Chlamydia).
Culture Additional bacterial cultures can be added (e.g. placenta, other tissues showing lesions).
Fungal culture can be added as required (e.g. placenta, lesions).
Histopathology Take one sample (1cm thick x 2-3 cm) of each tissue. All tissues can be submitted in one leak-proof pot, if adequate formalin. In addition to standard range of tissues, include any other lesion or tissue showing lesions.
Case will be billed based on number of tissues submitted.
Summary
Fresh placenta, lung, liver, spleen, thymus for EHV-1 PCR, Chlamydia psittaci PCR, +/- EHV-4 PCR - separate labelled sterile pots - OR for placenta, single dry swab (multiple sites across placenta)
Fresh stomach contents, fresh lung for Bacterial culture
- separate labelled pot (or swabs)
Formalin-fixed placenta, lung, liver, spleen, thymus for Histopathology
- one leak-proof pot with adequate formalin
Sample required:
- Serum (0.5 mL) or Clotted Blood (1.5 mL)
Blood tube required:
- Plain (red top) or Gel (yellow top) tube (It is recommended that a sample is submitted concurrently in a fluoride oxalate tube (grey top) for blood glucose determination)
To assess for insulin resistance.
- May aid in the diagnosis of equine metabolic syndrome (EMS) and pituitary intermedia dysfunction (PPID; Cushings – like syndrome).
Indications:
- To assess for insulin resistance.
- May aid in the diagnosis of equine metabolic syndrome (EMS) and pituitary intermedia dysfunction (PPID;
Cushings – like syndrome).
Protocol:
- Withhold feed for 6 hours prior to sample collection. As a guideline, it is recommended that not more than 1 biscuit of low non-structural carbohydrate grass hay per 500 kg bodyweight is provided no later than 10 pm the night before sampling.
- Collect blood sample, ideally between 8 am and 10 am.
- Store sample at 4°C. If transport to the laboratory will be delayed (> 12 hours), the sample should be centrifuged and the serum separated.
EMS is a complex syndrome. The diagnosis is based on a complete history, performing a thorough physical examination (including assessment of regional adiposity and body condition scoring), documented evidence of insulin resistance, and results of additional diagnostic tests (serum triglycerides, radiographs of the feet etc).
- Assessment of insulin/glucose concentrations should be made in the absence of possible confounding factors such as stress, pain (e.g. laminitis), inflammatory disease, administration of α2-agonist drugs (e.g. xylazine, detomidine), and recent feeding.
- If single insulin/glucose measurements are equivocal, dynamic tests for insulin resistance may be required (e.g. oral or IV glucose tolerance test, combined glucose-insulin test).
- Hyperglycaemia is rarely present in horses with EMS, however blood glucose concentrations tend towards the upper end of the reference interval.
SAMPLEREQUIRED:
Body fluid minimum 0.5mL, or FNA sample
BLOOD TUBE REQUIRED:
EDTA or Plain sterile
- This test is indicated for feline patients with pericardial, pleural or peritoneal effusions, and clinical suspicion for feline infectious peritonitis (FIP) caused by Feline Coronavirus (FCoV).
- FCoV can be detected in macrophages using a fluorescent-labelled antibody to FCoV types I and II with high specificity. Sensitivity is somewhat limited by the typically low nucleated cellularity of FIP effusions, and so false negatives occur.
- Body fluid immunofluorescence is best performed following body fluid analysis (403) with cytology to evaluate fluid characteristics.
- Body fluids (pleural, peritoneal or pericardial) collected into an EDTA or sterile plain tube.
- Unstained fine needle aspirate smears, or (preferably) aspirated material collected into an EDTA tube with 0.5mL sterile 0.9% saline. If smears are submitted, please indicate on submission form that these are not to be stained.
- Samples should be as fresh as possible (no older than 5-6 days).
- Samples received on Thursday or Friday may have a delay in results (results expected early the following week).
- Results are reported as positive or negative for FCoV antibody immunofluorescence. A positive result is highly specific for FIP (100%), while a negative result does not exclude FIP (75% sensitivity).
- Body fluid albumin, globulin and A:G ratio are included.
Sample required:
Dry cotton swab in sterile container (no transport media)
Test use:
This test is based on PCR technology, designed to identify the presence or absence of these infectious agents. ThePCR test is the preferred test for these infections, with both good sensitivity and specificity. It is important to note however, that due to the nature of these organisms, false negative results are possible. To maximise the possibility of successful recovery of organisms, samples should be collected during the acute phase of infection and prior to any therapy. Chronicity of infection and therapy (especially for Chlamydia) will lead to a lowering of virus/Chlamydia particle production.
- NOTE: The sample should be collected before any use of fluorescein and should be transported dry, not inany transport medium. Both fluorescein and transport media may interfere with the test procedure.
- A swab is used to obtain a sample from affected areas, most commonly the conjunctival sac and oropharynx.Visible lesions in the nasal and oral cavities should be sampled. Local anaesthetic drops can be used if the cat is fractious.
- The swab should be moistened with sterile saline and rubbed vigorously across the affected areas/conjunctival sac in an effort to obtain epithelial cells that may contain infectious organisms.
- Place the swab into a sterile sealed container and store at 4°C until transport to the lab.
Sample required:
May be performed on blood, bone marrow, body cavity fluids, and aspirates of solid tissues placed into liquid media (see below).
General sample collection requirements:
- The sample should be collected early in the week and sent to the laboratory as soon as possible. Samples must be received at the laboratory by Wednesday. Samples collected later in the week or on the weekend may deteriorate and will therefore not be suitable for analysis.
- Refrigerate samples immediately after collection. Keep refrigerated until courier collection.
- Ensure a thorough history accompanies the submission. This should include:
- Signalment
- General clinical history
- Results of any laboratory testing, including CBC/biochemistry, cytology reports,histopathology reports, serological test results etc.
- A specific reason for why the test has been requested (e.g. to classify a leukaemia, todifferentiate between a reactive and neoplastic lymphoid population, to classify alymphoid neoplasm as B or T-cell etc).
Specific sample collection requirements:
Further investigation of an acute leukaemia or persistent lymphocytosis
- Refer to general sample collection requirements above.
- Minimum sample requirements are 2 tubes containing at least 2 mLs of fresh, chilled, non clotted EDTA blood and an air dried blood smear (made at the time of blood collection).
- Submit a copy of recent haematology reports, including pathologist interpretation comments (if performed at a different laboratory).
Further investigation of a lymphocyte-rich body cavity effusion
- Refer to general sample collection requirements above.
- Collect the cavity fluid into an EDTA (purple top) tube and gently invert 8-10 times, ensuring thatno clot is present.
Lymph node and other organ aspirates for flow cytometry
- Refer to general sample collection requirements above.
- Place 1 mL of saline (0.9% NaCl solution but not Hartmann's solution) in a 2 mL EDTA tube and add 0.1 to 0.2 mL of serum from the patient or another animal of the same species to the tube.
- Aspirate the lymph node or other organ mass using suction and squirt the contents of the needle and syringe into the tube.
- Draw up saline through the needle and gently squirt back into tube to obtain more cells.
- Carry out this process several times if possible – the saline should be cloudy.
- It is also recommended that 3-4 well made smears be made by direct FNA of the lymph node or mass in question for simultaneous cytological examination.
Flow cytometry is a versatile and powerful technique using laser-based technology that allows for qualitative and quantitative assessment of multiple parameters of individual cells and particles. It may be used for cell counting, cell sorting and cellular marker detection (i.e. immunophenotyping).Flow cytometers detect and analyse multiple physical characteristics of single particles (cells) as they flow in a fluid stream through a beam of light. The properties analysed include a particle's relative size, relative granularity or internal complexity and relative fluroescence intensity. Fluorescently labelled antibodies may also be applied to detect expression of specific cell markers, there by assisting with identification and quantification of specific cell types, cell subsets, and cells expressing aberrant antigens.
- To allow differentiation and further classification between acute lymphoid and acute myeloidleukaemias.
- To help differentiate between reactive and neoplastic expansions of lymphocytes.
- To differentiate between B and T cell lymphoid neoplasms (lymphoma, chronic lymphocyticleukaemia etc.).
- Animals should ideally not have been treated with any chemotherapeutic agents, including corticosteroids, prior to the first immunophenotyping test when using flow cytometry. Antigens can be downregulated on lymphocytes after treatment.
- Samples will not be diagnostic if there are insufficient numbers of the neoplastic cells in question or the cells have deteriorated or are lysed. Samples of cerebrospinal fluid are usually of too low cellularity to perform immunophenotyping using flow cytometry.
- In some cases, immunophenotyping by flow cytometry may not be diagnostic due to downregulation or aberrant expression of cell antigens in neoplastic cells.
- In rare cases, certain infectious diseases can cause clonal or restricted expansions of lymphocytes, which can mimic lymphoid neoplasia.
- To assist in the diagnosis of diabetes mellitus in dogs and cats.
- In particular, fructosamine is useful to help differentiate between diabetes mellitus and stress hyperglycaemia (particularlyin cats with a blood glucose > 12 mmol/L).
- For monitoring glycaemic control in diabetic dogs and cats.
- It is preferable to fast the animal for 12 hours prior to sample collection, though a random sample can be used if necessary.
- Collect blood sample.
- Store sample at 4°C. If transport to the laboratory will be delayed (> 12 hours), the sample should be centrifuged and the serum separated.
- Fructosamine is a glycated serum protein and provides an assessment of average blood glucose over the preceding 2-3weeks in dogs and possibly a shorter timeframe in cats (7-10 days). It is not affected by acute increases in blood glucose(e.g. due to stress or excitement).
- In cats, a persistently stressful state may occasionally produce a significant elevation in fructosamine.
- Fructosamine concentration is affected by factors that alter the half-life of serum proteins. Hypothyroidism in dogs may increase serum fructosamine concentration. Hyperthyroidism in cats and severe hypoproteinaemia may decrease serumfructosamine concentration.
- Significant decreases in fructosamine concentration can occur if samples are kept at room temperature for more than a few hours (e.g. a 10% decrease can occur in 12 hours).
- Fructosamine concentration will not detect animals experiencing the Somogyi phenomenon while receiving insulin therapy.
SAMPLE REQUIRED:
Serum (1.5 mL) Fresh or Frozen
BLOOD TUBE REQUIRED:
Plain (Red Top) Tube
Note Gel Tubes are NOT suitable
Further assessment of high or low serum total calcium concentration.
- A 12 hour fast prior to sample collection is preferable but usually not essential.
- Blood sample must be collected and processed anaerobically as described below.
- Jugular venipuncture is preferred as application of a tourniquet and subsequent blood stasis may alter serum
- ionised calcium.
- Collect at least 3-5 mL blood directly into a plain (red top) vacutainer.
- Allow the blood to clot at room temperature (15-30 minutes).
- Centrifuge the sample and harvest the serum anaerobically as follows:
- Using an evacuated syringe and needle, pierce through the cap of the vacutainer. Aspirate the serum, taking great care to avoid aspirating red cells.
- Transfer the harvested serum into a second plain (red top) vacutainer, inserting the needle through the cap of the tube.
- The tubes should not be uncapped under any circumstances.
- Ideally obtain two separate 1.5 mL aliquots of serum.
- Serum should be transported to the laboratory as soon as possible (ideally arriving at the laboratory within 48
- hours). If a longer delay is anticipated then the serum should be frozen and transported to the laboratory on
- dry ice (contact the laboratory to arrange special collection).
- On the laboratory submission form, write the venipuncture site.
Serum should be harvested within one hour of blood collection. Delayed harvesting can lead to a falsely increased ionised calcium concentration.
As a guide, serum ionised calcium is stable for:
4 hours at 22C
7 days at 4C
6 weeks at -20C
If PTH is also required on the same serum sample, note the following points (see PTH protocol):
- Submit at least 2.5 mL serum.
- Freeze the serum as soon as possible after sample collection.
Note: Ionised calcium concentrations are very sensitive to changes in sample pH. It is therefore recommended that, wherever possible, ionised calcium concentrations are assessed immediately at the time of collection (e.g using an I-Stat). If this is not possible, the protocol below should be strictly followed.
Sample required:
Fresh / frozen / formalin fixed** tissuePreferably > 100 mg wet weight (preferred minimum 30 mg wet weight)
Tube required:
Plain (non-additive) tube/vial
Test use
Copper can accumulate in hepatocytes due to excessive dietary intake, cholestasis or altered hepatocyte metabolism preventing copper excretion. Excessive intracellular copper can result in cellular damage due to formation of oxygen free radicals.
Copper associated chronic hepatitis has been documented in Bedlington Terriers, Doberman pinschers, Cocker spaniels, West Highland white terriers, Standard poodles, Dalmatians, English Springer spaniels, Samoyeds, Cairn terriers, Skye terriers, Anatolian Shepherd dogs, Welsh Corgis, Keeshonds, Great Danes and Labrador retrievers. Inherited disorders preventing hepatic copper excretion have been proven in both the Bedlington terrier and Labrador retriever, although an inherited defect is suspected in many other breeds.
Fresh chilled liver is the preferred sample. Samples should be placed into containers suitable for the sample size and chilled as quickly as possible.
For samples collected at post mortem, a sample size of 5 - 10 g in a 50 mL plastic screw-top container is preferred.Fresh tissue samples should be frozen if shipment will be delayed more than 2-3 days. Frozen samples are stable for several months. Extensive autolysis of liver samples may result in reduced mineral concentrations in the tissue.
For biopsy samples, a minimum biopsy weight of 100 mg is requested. Smaller samples can still be processed; however, biopsy samples <30mg require a different assay method/QC and are approximately twice the price of routine assays.
Biopsy samples must be gently rinsed with saline and excess fluid/blood removed by gently blotting with lint-free tissue or gauze swabs. Place the sample into a 1.5 mL 'O’-ring sealed plastic vial/tube. The entire contents of the biopsy vial, including any water condensate from the biopsy, will be assumed to be liver; therefore, it is vital that clots and excess blood/fluid are removed from the initial sample.
**Formalin fixed tissue samples may also be used for copper estimation, provided samples are of sufficient size to allow trimming of all external tissue surfaces.
- Results are reported as SI units of mmol per kg wet weight. For an approximate conversion to dry weight, multiply result by 3.6. For conversion to mg per kg wet weight, multiply mmol per kg wet weight by atomic weight of element (63.5 for copper).
- If liver copper/B12/GSHPx is required, then minimum biopsy size is 100 mg. If Manganese is also required then minimum biopsy size is 250 mg. If Selenium required vs GSHPx, minimum biopsy size is 500mg.
- If iron is required a separate biopsy (minimum 30 mg) is needed.
Sample required:
Serum (0.5 mL) or clotted blood (1.5 mL)
Blood tube required:
Gel (gold top) or plain (red top) tubes.
To assist in the diagnosis of hyperadrenocorticism (Cushing’s syndrome) in dogs. If results of pituitary - adrenal testing confirm hyperadrenocorticism, the LDDST results can also be used as an aid in discriminating between pituitary and adrenal dependant hyperadrenocorticism.
- If glucocorticoids have been administered recently, refer to Notes below• Maintain the dog in a stress free environment
- 8.00 am: Collect a resting blood sample and label it with patient details and ‘0 hr’
- 8.00 am: Administer dexamethasone sodium phosphate at 0.01 mg/kg IV
- 12.00 pm: Collect a 4-hour post-dexamethasone blood sample and label it with patient details and ‘4 hr’
- 4.00 pm: Collect an 8-hour post-dexamethasone blood sample and label it ‘8 hr’
- Stores samples at 4°C and submit all three samples together to the laboratory. If transport to the laboratory will bedelayed (> 12 hours), the samples should be centrifuged and the serum separated.
- On the laboratory submission form, list samples as well as collection intervals.
- The time of day is not critical but serves as a guide.
- Specific testing for hyperadrenocorticism should not be performed in unwell or significantly stressed animals, whichmay yield false positive results in adrenal function tests. In potentially hyperadrencorticoid dogs with significant intercurrent disease such as diabetic ketoacidosis or pancreatitis, adrenal function testing should be delayed until intercurrent disease is controlled.
- Any form of corticosteroid therapy may interfere with adrenal function tests, by (a) cross-reacting in the cortisol assay (except for dexamethasone), or (b) affecting the pituitary/adrenal axis via suppression of ACTH production. As a guide, the minimum periods for which corticosteroid therapy should be withheld before LDDS tests are:
- Injectable (short acting) 7 days (48 hr if dexamethasone)
- Oral 2 weeks
- Topical 2 weeks
- Injectable (depot) 2 months
Sample required:
Serum (0.5 mL) or Clotted blood (1.5 mL)
Blood tube required:
Plain (red top) tube or Gel (yellow top) tube
To assist in the diagnosis of hyperadrenocorticism (Cushing’s disease) in cats.
- If glucocorticoids have been administered recently, refer to Notes below.
- Maintain the cat in a stress free environment, especially in the 72 hours prior to testing.
- 8 am: Collect a resting blood sample and label it “0 h”.
- 8 am: Administer dexamethasone sodium phosphate at 0.1 mg/kg IV.
- 12 noon: Collect a 4-hour post-dexamethasone blood sample and label it “4 h”.
- 4 pm: Collect an 8-hour post-dexamethasone blood sample and label it “8 h”.
- Store samples at 4°C and submit all 3 samples together to the laboratory. If transport to the laboratorywill be delayed (> 12 hours), the samples should be centrifuged and the serum separated.
- On the laboratory submission form, list samples and collection intervals.
- The time of day is not critical but serves as a guide.
- The dexamethasone dose rate is 10x higher in cats than dogs.
- Specific testing for hyperadrenocorticism should not be performed in unwell or significantly stressed animals, which may yield false positive results in adrenal function tests. In potentially hyperadrenocorticoid cats with significant intercurrent disease such as diabetic ketoacidosis orpancreatitis, adrenal function testing should be delayed until intercurrent disease is controlled.
- Any form of corticosteroid therapy may interfere with adrenal function tests, by (a) cross-reacting in the cortisol assay (except for dexamethasone), or (b) affecting the pituitary/adrenal axis via suppression of ACTH production. As a guide, the minimum periods for which corticosteroid therapy should be withheld before a LDDS test are:
- Injectable (short acting) 7 days (48 h if dexamethasone)
- Oral 2 weeks
- Topical 2 weeks
- Injectable (depot) 2 months
Sample required:
Frozen serum, minimum 1.0mL
Blood tube required:
Serum tube, red top
Canine PTH can now be run at Vetnostics in Sydney. This assay has currently only been validated in dogs, and an interim reference interval has been established and may be refined over time.
Feline and equine samples are still sent overseas for analysis. Please call to discuss further if you would like to discuss the limitations of performing this test in these species.
Note that PTHrP testing is not currently available in Australia.
Investigation of unexplained hypercalcaemia or hypocalcaemia.
- A fasting sample is preferred.
- Collect at least 2mL of blood directly into a plain (red top) vacutainer.
- Allow the blood to clot at room temperature (15-30 minutes).
- Centrifuge the sample and transfer serum into a second plain (red top) tube with no additives
- Freeze serum and call the lab to request a dry ice pick up (Melbourne metro clients); regional clinics will need to contact the laboratory to discuss transport options
- If ionised calcium is also required, a separate tube will be required. Please see the collection protocol for ionised calcium for sample handling requirements.
- If ionised calcium is assayed in-house (recommended at time of PTH sample collection), please submit the ionised calcium result along with the submission form.
- A full clinical history (biochemistry, imaging, clinical examination findings, medications, etc.) is required to assist with result interpretation.
Interpretation:
Sample required:
Serum (0.5 mL) or Clotted blood (1.5 mL)
Blood tube required:
Plain (red top) tube
Monitoring of serum phenobarbital concentration in dogs and cats being managed for seizures.
- Fast the patient for 12 hours (overnight).
- Collect blood sample within one hour of the next scheduled dose (trough concentration).
- If a peak phenobarbital concentration is required, the sample should be collected 4-5 hours after dosing.
- Store sample at 4°C. If transport to the laboratory will be delayed (> 12 hours), the sample should be centrifuged and the serum separated.
- Gel/serum separator tubes are not recommended as the gel may absorb some of the drug, artificially lowering the serum concentration.
- It is generally accepted that trough phenobarbital concentrations be assessed in most cases.
- Steady-state serum and tissue phenobarbital concentrations are achieved after 7-10 days of therapy.
- Induction of liver enzymes (ALP and to a lesser extent ALT) is common in animals receiving phenobarbital therapy.
- Side-effects of phenobarbital administration may include hepatotoxicity and blood dyscrasias. In addition to monitoring serum phenobarbital concentration, assessment of a complete blood count (CBC) and biochemistry panel is recommended every 6-12 months. If there is concern for liver dysfunction, assessment of fasting and post-prandial bile acids is also recommended.
- Hepatic microsomal enzyme induction may occur with time, decreasing the elimination half-life of the drug and potentially requiring an increase in dosage. Conversely if liver function is impaired, the elimination half-life may increase, requiring a decrease in dosage and/or change in anticonvulsant medication.
Recommendations for when to assess phenobarbital concentration:
- 2 and 6 weeks after commencement of therapy
- 2 weeks after any change in dose
- If significant side effects develop
- Every 6 months when seizures are well controlled
- If >2 seizure events occur between these times
Sample required:
Serum (0.5 mL) or Clotted blood (1.5 mL)
Blood tube required:
Plain (red top) tube
Monitoring of serum potassium bromide concentration in dogs being managed for seizures.
- Fast the patient for 12 hours (overnight).
- Collect blood sample within one hour of the next scheduled dose (trough concentration). Once steady-state concentration has been reached, samples can be collected at any time point >2hours after dosing.
- Store sample at 4°C. If transport to the laboratory will be delayed (> 12 hours), the sample should be centrifuged and the serum separated.
- Gel/serum separator tubes are not recommended as the gel may absorb some of the drug, artificially lowering the serum concentration.
- The half-life of bromide is approximately 21 days in dogs, although variability among animalsmay be marked. Bromide concentrations may be influenced by dietary chloride intake.
- Steady-state serum bromide concentrations are achieved after approximately 2.5-3 months of therapy.
Recommendations for when to assess potassium bromide concentration:
- 1 and 3 months after commencement of therapy
- 1 month after a change in dose
- Every 12 months for long-term therapy
- When signs of dose-related toxicity develop, such as ataxia or sedation.
- If > 3 seizures occur between these times
To aid in the assessment of thyroid status in dogs. TSH production and secretion is controlled by negative feedback from the thyroid hormones T4 and T3, as well as by secretion of the hypothalamic hormone thyrotropin releasing hormone (TRH). Most cases of canine hypothyroidism are primary, due to impaired production of T4 and T3. Due to the loss of negative feedback, TSH is increased in many of these cases.
- No special preparations are necessary.
- Collect blood sample.
- Store the sample at 4°C. If transport to the laboratory will be delayed (> 12 hours), the sample should be centrifuged and the serum separated.
Sample required:
Serum (0.5 mL) or clotted blood (1.5 mL)
Blood tube required:
Gel (gold top) or plain (red top) tubes.
Diagnosis of hypothyroidism.
Monitoring thyroid replacement therapy.
General
- Ideally fast the animal for 12 h.
- Collect blood sample.
- Store the sample at 4°C. If transport to the laboratory will be delayed (> 12 hours), the sample should be centrifuged and the serum separated.
Monitoring therapy
- This is usually done 4-8 weeks after initiating thyroxine therapy, or 2-4 weeks after a change in dose rate.
- Collect a sample 4-6 hours after administration of thyroxine.
Review of thyroid status in a dog currently receiving thyroid hormone supplementation
Exogenous thyroid hormone can suppress TSH secretion resulting in thyroid gland atrophy, and thus a low serum total T4 could suggest hypothyroidism (even in a previously euthyroid dog). To obtain a valid baseline total T4 result, thyroid hormone supplementation must be discontinued for a period of time to allow the pituitary-thyroid axis sufficient time to regain normal function. That time interval depends on the duration of treatment, the dosage and frequency of administration thyroxine and individual animal variation. As a guide, thyroid hormone supplementation should be discontinued for a minimum of 4weeks, and preferably 6-8 weeks before re-evaluation of thyroid gland function.
- Total T4 provides an appropriate initial assessment of thyroid function in dogs.
- Free T4 (by equilibrium dialysis) is a more reliable test for evaluation of thyroid function in dogs with concurrent medical problems , as it is less likely to be suppressed by non-thyroidal illness or drug therapy.
- Drugs that may lower total T4 concentration include glucocorticoids, sulphonamides, phenobarbital, carprofen, and clomipramine.
- To support a presumptive diagnosis of hypothyroidism based on total T4, further diagnostic options include endogenous TSH and free T4 (by equilibrium dialysis).
Sample required:
Serum (0.5 mL) or clotted blood (1.5 mL)
Blood tube required:
Gel (gold top) or plain (red top) tubes.
General
- Ideally fast the animal for 12 h.
- Collect blood sample.
- Store the sample at 4°C. If transport to the laboratory will be delayed (> 12 hours), the sample should be centrifuged and the serum separated.
Monitoring therapy – Oral dosing
- Collect a random blood sample for total T4 determination 2-3 weeks after initiating therapy or after dosage changes.
- On the laboratory submission form, note the form of therapy used.
Monitoring therapy – Transdermal (PLO) dosing
- Collect a random blood sample for total T4 determination 4 weeks after initiating therapy or after dosage changes.
- On the laboratory submission form, note the form of therapy used.
Diagnosis of hyperthyroidism.
Monitoring treatment of hyperthyroidism.
Sample required:
Serum (0.5 mL) or Clotted Blood (1 mL)
Blood tube required:
Plain (red top) or Gel (yellow top) tube
Test use:
To assist in the diagnosis of exocrine pancreatic insufficiency (EPI) in dogs.
- Fast the patient for 12 hours. Failure to fast the dog before sample collection may increase the TLI.
- Collect blood sample.
- Store sample at 4°C. If transport to the laboratory will be delayed (> 12 hours), the sample should be centrifuged and the serum separated.
- Treatment with pancreatic enzyme supplements does not affect serum TLI concentration.
- Concurrent intestinal disease does not affect serum TLI concentration.
- Active pancreatitis, marked reduction in GFR, and malnourishment may increase serum TLI concentration.
Sample required:
Urine, minimum 10mL, frozen
Blood tube required:
Sterile container, frozen
Interpretation:
The following results are reported:
- Metanephrine, normetanephrine, epinephrine and norepinephrine concentrations
- Metanephrine/creatinine ratio and normetanephrine/creatinine ratio, with appropriate reference intervals and interpretive guidelines
For evaluation of adrenal masses where excessive catecholamine production is clinically suspected.
- The owner is to collect a urine sample (minimum 10mL) at home (stress-free conditions) and then freeze immediately.
- The sample must then remain frozen the entire time prior to submission and samples must then be sent frozen to the laboratory.
- Specifically request a dry ice pick-up collection by courier.
Sample required:
Urine (2.0ml)
Test Use:
- The urine cortisol creatinine ratio is a highly sensitive screening test for hyperadrenocorticism in dogs.
- However it lacks specificity and does not replace the low dose dexamethasone suppression test or the ACTH stimulation test as a routine screening test for hyperadrenocorticism.
- It is more useful for ruling out hyperadrenocorticism in dogs with a low clinical index of suspicion.
- It may be useful in dogs that are difficult to handle.
- If glucocorticoids have been administered recently, refer to Notes below.
- As much as possible, maintain the dog in a stress free environment for 24 h prior to urine collection.
- Preferably collect the urine in the morning.
Screening for hyperadrenocorticism should not be performed in unwell or significantly stressed animals, which may yield false positive results in adrenal function tests. In potentially hyperadrenocorticoid dogs with significant intercurrent disease such as diabetic ketoacidosis or pancreatitis, adrenal function testing should be delayed until intercurrent disease is controlled.
Any form of corticosteroid therapy may interfere with adrenal function tests, partly by affecting the pituitary/adrenal axis via suppression of ACTH production. As a guide, the minimum periods for which corticosteroid therapy should be withheld before adrenal function testing are:
- Injectable (short acting) 7 days (48 h if dexamethasone)
- Oral 2 weeks
- Topical 2 weeks
- Injectable (depot) 2 months
Sample required:
Plasma (2.0 mL)
Blood tube required:
Sodium Citrate (blue top) tube for initial collection and then plasma transferred to plain (non-additive) tube and frozen
This test is used in the diagnosis of von Willebrand factor deficiency (von Willebrand’s disease) in dogs.
Animal Requirements:
- • It is important to note Von Willebrand‘s factor may increase in response to stress, acute haemorrhage, inflammation or infection. Hence avoid collecting blood from bitches that are in season, pregnant or lactating, dogs that are unwell, have recently undergone surgery, or have had a recent episode of haemorrhage.
- The patient should be fasted for about 12 hours prior to sample collection. The patient must be resting at the time of collection and care should be taken to avoid any stress or excitement. Sedation of the patient may be necessary in some circumstances.
Sample Requirements:
- It is essential that a “clean” venipuncture is made for sample collection. If any difficulty occurs, a new needle and syringe should be used for recollection.
- Collect blood into a sodium citrate (blue top) tube. Ensure that the tube is filled to the correct line (a minimum of 2 mL of plasma is required for the assay). Fill 2 tubes if possible when using 2 mL citrate tubes. Ensure the sample does not contain any clots.
- Centrifuge the sample immediately. Remove the plasma using a plastic pipette. The plasma should be placed into a plain (non-additive) plastic tube. Note: Do not use a plain (red top) vacutainer tube as these contain a clot activator.
- If sample receipt at the laboratory can be guaranteed within 24 hours of collection it should be refrigerated at 4°C and kept cool during transportation to the laboratory, ideally in an esky with icepacks.
- If a delay of more than 24 hours between collection and receipt at the laboratory is expected, freeze the plasma immediately after collection. The plasma must remain frozen and transported on dry ice. Contact the laboratory to organise a dry ice collection.
If a centrifuge is not available and a whole blood sample is being transported to the laboratory, the sample should be wrapped in cotton wool or newspaper and then placed in an esky with ice packs and transferred to the laboratory as soon as possible. Direct contact with the ice packs is to be avoided, as this may cause haemolysis. Do not freeze whole blood.
Submission of whole blood is discouraged as this may lead to sample haemolysis and von Willebrand factor deterioration/loss, affecting the validity of the result.