help for friends civie-few platelets

Her cat Tashie was supposed to go in for a dental but they stopped when they saw her blood tests. She had few platelets, but her RBCs and WBCs are fine and her liver and kidneys are fine.. She doesnt think she got into any of her meds. If the RBCs and WBCs are ok how can there be few platelets? off to google some more.

 

How were the number of platelets determined? A lot of times they are counted by machine. However, in many felines the platelets clump together and thus the machine does not count them. I have seem many lab reports that reported low platelets but with an annotation that said a slide with blood was examined under a microscope and clumping was observed and the number of platelets is consider acceptable.

 

Thanks Larry, I asked her that and she said no clumping, just not many of them. I believe it was inhouse because they knew right then before the dental. they are sending out blood to lab now.

 

Hi Lisa

If it's real (the low platelets), it would be because she's either not producing them or her body is destroying them. Neither of these points to anything good, as you can imagine. However I wouldn't start any hand-wringing until you get the lab results. If it's abnormal, they can ask the lab to have a pathologist (board-certified vet with specialty in reading cells on slides) review her blood. They also should (if they haven't already) send out a full coagulation profile to determine if there are any other issues with clotting.

Uncommonly, the blood draw technique will cause a false reading of low platelets; in an asymptomatic cat, it should always be repeated (fresh venipuncture, clean stick with no poking around to find the vein to get new sample) and then sent to the lab.

I'm saying to wait to worry in large part because a cat with significantly low platelets (the official name is thrombocytopenia) usually has other signs. It's really a very serious condition and an affected cat is in (depending on the severity) sometimes imminent danger of bleeding to death. [Don't tell your friends all this, BTW, let's wait till they get a definitive answer.] Signs include petichiae (as in petichial hemorrhaging, like they say in CSI), extensive bruising, swelling (due to bleeding under the skin), bloody nose, bloody drool ... you get the idea.

So, the primary suspects would be infectious disease (usually viral, like FeLV), cancer, another source of severe inflammation, or (less common) auto-immune disease. This is assuming the cat is not on any new drugs and has not eaten anything toxic like certain human meds. My vote right now would be for some kind of lab error or venipuncture snafu ... Keep us posted.


PS When I worked in critical care we had a severely thrombocytopenic Dachshund in on emergency once who had a huge bruise from being carried with a hand under the chest -- it was like a grotesque smudgy handprint. No pressure on me to get the IV in with one clean stick, of course! It was nerve-wracking, Dachshunds have those difficult stumpy legs and he would have bled forever if I stuck and didn't get the IV on one try which thank goodness I did.

 

Another possible culprit would be a clotted specimen. Those can sometimes be missed if the clot in the tube is small (or if they don't check for clots to begin with!)or if the clot is left behind in a syringe. I see lots of these working in a pediatric facility.

If the plt count is critically low, they should be seeing some symptoms. If there are no symptoms, I would question the sample integrity.

 

Ok, she oked me posting labs here.. cat is 9 yr old torti point siamese/snowshoe mix.
They did do 2 samples..
first one was wacky, 2nd not so wacky.. and cat didnt even bruise at the venipuncture site.

CBC COMPREHENSIVE

Test Result Reference Range Low Normal High

WBC 5.5 4.2 - 15.6 THOUS./uL
RBC 9.54 6.0 - 10.0 MILLION/uL
HGB 14.0 9.5 - 15 g/dL
HCT 47.3 29 - 45 % HIGH
MCV 50 41 - 58 fL
MCH 14.7 11.0 - 17.5 pg
MCHC 29.6 29 - 36 g/dL
NEUTROPHIL SEG 85 35 - 75 % HIGH
LYMPHOCYTES 12 20 - 55 % LOW
MONOCYTES 2 1 - 4 %
EOSINOPHIL 2 2 - 12 %
BASOPHIL 0 0 - 1 %
AUTO PLATELET 248 170 - 600 THOUS./uL
POIKILOCYTOSIS SLIGHT
REMARKS SLIDE REVIEWED MICROSCOPICALLY.PLEASE SEE ADDITIONAL PATHOLOGIST COMMENT.***THIS IS AN AMENDED REPORT. PATHOLOGIST REVIEW REQUESTED BY THECLIENT.***

ABSOLUTE NEUTROPHIL SEG 4675 2500 - 12500 /uL
ABSOLUTE LYMPHOCYTE 660 1500 - 7000 /uL LOW
ABSOLUTE MONOCYTE 110 0 - 850 /uL
ABSOLUTE EOSINOPHIL 110 0 - 1500 /uL
ABSOLUTE BASOPHIL 0 0 - 100 /uL


CLIN PATH REVIEW

Test Result
CLIN PATH REVIEW The blood smear is reviewed as requested. History indicates apreanesthetic analysis with equivocal clotting results using SST. Iconcur with report findings on the CBC. There is some red cellcrenation artifact but an otherwise normal erythron. Platelets areadequate. Leukocyte morphology is unremarkable. No organisms areinclusions were found. Clotting in the serum separate are tube is arough estimate of clotting capability in vitro and there can beartifactual reasons for failure to clot such as exposure of the sampleto cold, inadvertent exposure to anticoagulant, or faulty SST withinterfering substance. Consider PT/PTT screen if history or otherfindings warrant.

 

The platelet count is within the range:
AUTO PLATELET 248 170 - 600 THOUS./uL

Also the CLIN PATH REVIEW concluded platelets are adequate as is clotting and really no abnormalities were found.

Is any further action planned? The HCT was a little high. That could be due to slight dehydration. Do you have the total protein value for the blood serum? If high that would also indicate dehydration.

 

ok weird, the second blood draw was used for both the second inhouse test and the send out Idexx test. Results above are the idexx send out test. the platelets are the same, but on the inhouse test the low on the ref range was 300 so 248 was out of range. The first inhouse draw it was 140.

Clearly, something wacky is going on with the inhouse testing.

Total protein on the first inhouse test was 7.0 ref range 5.4-8.2
on the inhouse test the hct was normal.

 

Am i missing something? Where are the questionable results?

 

um yea, I think the questionable ones were sent to me later, the inhouse ones were the weird ones. The one I posted was the send out test. But that means the inhouse testing messed up 2 different samples.