Advanced Technologies of In-Clinic Hematology Analyzers: Not All Are Created Equal

The availability of in-clinic laboratory equipment within veterinary medicine allows you to run labwork "patient side." And with real-time diagnostics, you can develop timely and targeted treatment options and closely monitor response to therapy.

In my experience, robust in-clinic diagnostics can hit a sweet spot in practice, allowing for more advanced medical care, improved client satisfaction, and increased job satisfaction for doctors and technicians—all of which contribute to a thriving practice. Advanced technologies in hematology analyzers, specifically, have made significant impact on the accuracy of the blood cell analysis and allow for more comprehensive diagnoses.

Manual Cellular Analysis

Manual cell counting via microscopy is no longer the standard in hematology for pets. This is often due to the fact that the complete blood count (CBC) results obtained via microscopy aren't always accurate or precise due to the low number of cells reviewed—especially when compared with the tens of thousands of cells counted by automated analyzers. There is also subjectivity to microscopic analysis that can either be an added attribute, or negatively impact the accuracy of the diagnostic findings, depending on the level of expertise of the person at the scope. Additionally, manual microscopy naturally requires technicians' or doctors' time and attention which are great commodities in daily veterinary practice. Thus, automated analysis also begets efficiency and enhanced work flow.

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Flow Cytometry

Flow cytometry is a newer technology, utilized in both reference labs and in-clinic analyzers. Cells are interrogated by a laser and scattered light is then gathered to provide information about the cells' size and shape, nuclear size and shape, and cytoplasmic complexity. The end result is more accurate cell identification. For some analyzers, the addition of special stains allows for further cell distinction and identification of cell immaturity. The latter provides for enumeration of reticulocytes, or young red blood cells, needed to help determine the cause of a patient's anemia, as well as identification of band neutrophils, key in identifying inflammation in sick patients.

Impedance Technology

Electrical impedance is one of the older automated cell counting technologies and remains a commonly used methodology in current in-clinic hematology analyzers. Impedance does an excellent job at counting cells. The information for individual cell identification, however, is limited and thus cell differentials are not as accurate. Additionally, the technology utilizes size alone to distinguish between cell types, so pathologic size and shape changes seen frequently in sick animals further hinder accuracy of the reported CBC and its interpretation.

Enhance Patient Care via Technology

As a practitioner, it may be instinct to trust the automated data reported by your analyzers; however, not all analyzers are created equally. For instance, when it comes to sick patients with pathologic changes to their cells, the varied technology can result in spurious results. Knowing the technology of your hematology analyzer is key to understanding its strengths and, more importantly, the limitations of the automated data provided. Having advanced flow cytometry coupled with special staining capabilities provides more accurate and comprehensive CBC data than flow cytometry alone.

With enhanced data, in-clinic diagnostic testing can provide more effective and timely care. As technology within in-clinic hematology continues to advance, the different formats and ways for diagnosing specific conditions in patients will advance; however, their accuracy may vary.

Holly Brown
DVM, PhD, DACVP

Dr. Brown is a board-certified clinical pathologist with a passion for the practice of veterinary medicine. She left academia for a unique specialty position at a bustling general, referral, and emergency small-animal hospital in central Pennsylvania. There she enjoys contributing her pathology expertise patient-side, overseeing laboratory diagnostics, advising and educating clinicians and staff, and communicating with owners to help them better understand their pets’ laboratory abnormalities. Dr. Brown also provides continuing education on the value of laboratory diagnostics all over the globe. The views and opinions in this piece are the authors own, and do not necessarily reflect the views of either The Vetiverse or IDEXX.


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