Case of the Week: Snoopy

Case of the Week: Snoopy

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Case History

Snoopy, 10-year old, M/N, beagle named Snoopy presented with a temperature of 104.6F, anorexia, and lethargy. Snoopy had a history of dietary indiscretions and one day prior to presentation, an engorged tick was removed from his ventrum. Thoracic/abdominal radiographs and chemistry unremarkable. CBC: HCT 37%, WBC 5.99 K/uL, PLT 101,000/ul. Following IV antibiotic therapy overnight, Snoopy ate canned food, remained febrile, and continued to be lethargic. FNA of a prescapular lymph node was initially submitted, followed by blood smear review.

Scopio Practice Tip

Blood smear review is a great use of Scopio. CBC reports can be attached via the paperclip icon! In this case, a non-diagnostic lymph node aspirate was received and repeat submission offered at no charge, but this was also non-diagnostic. The clinical pathologist contacted the clinic in real time, via the Scopio chat feature, and requested a blood smear due to potential for tick-borne disease. Additional information provided by the clinic via chat included that an in-house Snap 4Dx test was negative, which is another reason to do a blood smear review. In acute anaplasmosis/ehrlichiosis, antibody based tests will be negative, but this is when morula are visible within leukocytes. After a non-diagnostic FNA sample, the blood smear revealed the diagnosis!

Webcam images with user chosen scan area denoted by thin green line.
Pink box includes monolayer & feathered edge, areas necessary for complete interpretation.

Microscopic Features

Lymph node aspirates

Interpretation: Leukopenia with probable rickettsial infection, probable mild thrombocytopenia, possible mild anemia.

How do we avoid qualifying language like “probable?” For blood smear review, including a recent CBC is essential to avoid speculative language, and in any case, complete history with clinical suspicion and diagnostic test results allows for more definitive interpretation.

Case of the Week patient information has been altered for client confidentiality.

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