Blood Collection Tubes

Serum Separator Tube

• Contains: separator gel and clot activator
• Common use: chemistry panel
• Blood is collected and tube should be inverted to mix in clotting factor
• Blood is allowed to clot and then spun down in centrifuge to remove serum from blood cells

Lavender top tube

• Contains: EDTA to prevent clotting of blood
• Common use: collection of whole blood for CBC – breakdown of red and white blood cells, viral tests
• Blood should be inserted by removing cap or with 22g or larger needle to prevent lysis of RBC
• Do not rock tube with needle inside tube – will become coated with CaEDTA
• Allow automatic fill with suction and then gently rock tube to mix cells and CaEDTA

Red top tube

• Does not contain the separator gel
• Common use: Phenobarbital levels
• A serum separator gel can interfere with the Phenobarbital level
• Contains: Potassium oxalate and sodium fluoride
• Common use: not commonly used, glucose level

Green TT:

• Contains: Lithium Heparin – to prevent clotting
• Common use: exotics with small sample can run both cbc and chem panel off one tube
• Use of plasma panels

Blue top tube

• Contains: Sodium citrate as an anticoagulant
• Common use: coagulation profiles
• Must completely fill the tube

BLOOD CIRCULATION THROUGH THE HEART

Blood flow shown with a square red heart (pump) in the middle of the drawing.

The pump is a box divided into 4 chambers:

• right and left atria and ventricles. The atria are on the top and the ventricles are on the botton. Blood flows through the AV valves between these chambers.
• The right side of the heart is accepting poorly oxygenated blood from the body and pumping to the lungs for oxygenation.The right side is a thinner/weaker muscle because the pump is only used to send blood to the lungs.
• The left side of the heart is a larger/thicker/stronger muscle because it is receiving well oxygenated blood from the lungs and then pumping it throughout the body.

BLOOD PRESSURE MEASUREMENT VIA DOPPLER

BLOOD PRESSURE

Blood pressure can be measured with many different devices and each hospital will have access to various equipment. However we use a Doppler unit with an ultrasonic probe and a cuff at our practice to obtain an indirect measurement of blood pressure on both dogs and cats and this is a vary common and reliable tool.

Doppler blood pressure is best used to measure systolic pressure and not diastolic pressures. One value is obtained and that is the reading on the gage, as the cuff is deflated, when the first sound is heard.
Normal animal pressures are 120/80 with the 120 being the systolic pressure and the 80 being the diastolic pressure.

Definition

• Systolic Pressure: The pressure in the arteries when the heart (ventricles) is at work or pumping out blood
• Diastolic Pressure: The pressure in the arteries when the heart (ventricles) is resting or filling up with blood.

Pitfalls when taking blood pressure include:

• A stressed patient in chaotic surroundings
• Incorrect cuff size
• Low volume – turn the sound of the Doppler up to hear the 1st sound.
• Cuff placed too tight or too lose
• Not getting an audible pulse sound with the probe prior to inflating the cuff.
• Not getting the average of several measurements
• Vessel not at heart level. Pet should be in lateral recumbency if using a digital artery.
• Not using headphones to better hear the first sound

Stress:

We like to place the pet in a darkened room on a comfy bed and have the owners talk to the pet while we are measuring the blood pressure to help calm the pet while obtaining measurement and this results in more accurate readings.

Sizing:
Blood pressure cuffs come in different sizes and it is important to select the correct size for the patient.
The width of the cuff needs to be between 0.3-0.4 times the diameter of the limb. To quickly check the fit of the cuff align the cuff with the limb lengthwise and the wide part of the cuff should go at least a quarter of the diameter around the limb and less than half way around the diameter

Too small a cuff: (width of cuff is less than 1/4 of limb circumference)
= too high a reading.

Too large a cuff:(width of the cuff is greater than 1/2 the circumference of the limb)
= too low a reading.

Use:

Regular blood pressure measurements can be useful for cats with kidney disease and hyperthyroidism and dogs with kidney disease or glomerulonephritis.

Placement:
Digital artery on the Palmar or Plantar aspect of foot
-or-
Tail base
Pet should be in lateral recumbency to ensure that the probe is level with the heart.

Correct placement involves setting the Doppler probe (with gel on it) over the arterial pulse which has been palpated.
The cuff is applied but not inflated and the Doppler should be checked to assure that the pulse is heard. The cuff is than inflated. If the cuff is inflated prior to listening to the pulse, the cuff could potentially be too tight which causes restriction of the vessel and results in an erroneous reading.

Ideal reading:
Goal is to keep the pressure between 100-150
If Too Low:

• Defined as: 70-80
• First check the patient: compare the mm color, heart rate, respiratory rate and pulse quality to pre-anesthesia results.
• If patient is too deep the vaporizer should be turned down
• If pressures are still low the pet should be bolused with IV fluids at 10ml/kg and the pressure is retaken.

MATH & CONVERSIONS

Remember pounds are larger than kilograms	Divide weight in pounds by 2.2 Example: 10 lb. dog/ 2.2 = 4.54 Kg
Convert MG of Drug into ML of Drug	Need to know the concentration (mg/ml) of drug Concentration is found on the bottle label (listed as mg/ml or as a percent) take Mg of drug needed and multiple by concentration on bottle EXAMPLE: 100Mg of Amoxicillin = 100/125 = 0.8ml
reconstitution of a Powder to Liquid for a Specific End mg/ml:	Concentration = mg/ml Example : A drug is labeled at 250mg/ml after reconstitution Bottle instructions: add 77ml sterile water to 25g to = 250mg/ml 77ml x 250mg/ml = 19290
change the concentration to 125mg/ml:	Take 19290/End concentration desired = cc sterile water to add Example: 19290/125 = 154cc sterile water
I’ve provided a few basic math formulas to help with calculations. I’ve made every effort to ensure accuracy but all calculations and formulas should be verified prior to use.

ENDOPARASITES = internal worms

A FEW OF THE MORE COMMON EXAMPLES

NEMATODES:

Roundworms or ascarids Round worm egss as seen under microscope	Ascarids: are large nematodes of several inches in length that live in the small intestines of dogs and cats. Studies have shown that >90% of puppies are infected with roundworms at birth. Zoonosis: YES visceral larval migrans with Toxocara canis Cutaneous larval migrans with toxocara cati Prepatent Period: T. canis 21-35 days , T. lenoina 72 days Time to become infectious: requires 4 weeks in the environment Diagnosis: eggs in feces, or adult worms, Float and direct , these are large eggs Hosts: transport host is an infected rodent or bird (second stage larva) Treatment: anthelmintics All puppies and kittens should be dewormed at least twice 2 weeks apart Clean up, eggs can survive extended periods in the soil 1.Toxocara canis (canine roundworm) puppies infected via placenta and mammary glands 2. Toxocara cati kittens infected via mammary glands 3. Toxascaris lenoina 4.Baylisascaris propyonis: raccoon roundworm, can infect pets
Hookworms: Ancylostoma Hookworm egg as seen under microscope	A gastrointestinal roundworm parasite of dogs and cats. In cats infection is via penetration of the skin whereas in dogs transmammary transmission occurs. This species is characterized by the presence of three cutting “teeth” on each side of the oral opening. Heavy infections cause severe anemia. 1. Ancylostoma caninum: dogs, racconns, coyotes… 2. Ancylostoma tubaeforme: cats Diagnosis: fecal float or direct: eggs are large, thin walled with mass of cells in the center (see above photo) Adults: are small parasites of only 1-2 cm and have cutting teeth Zoonosis: potential skin penetration Lifecycle: have a free living stage, can penetrate skin, 3rd stage larva are infectious Treatment: Fenbendazole (Panacur), ivermectin, pyrantel, praziquantel
WHIPWORMS: Trichuris vulpis	Eggs are oval shaped with “caps” on each end, adults have a “tail” that is curled like a whip Whipworms are another gastrointestinal nematode of dogs. Cats are rarely infected. Infection with whipworms can be mistaken for Addisons disease. They cause diarrhea +/- blood. Prepatent period: 3 months Diagnosis: fecal float or direct Treatment: anthelmintics to kill adults, treatment every 3 months to prevent Avoid infected soil, eggs can survive up to 2 years in soil
THREADWORMS: Strongyloides stercoralis	Threadworms are very small parasites of only a few mm in length and adult females live in the small intestines Infections is usually in animals < 6mos old and can involve the lungs and small intestines. Initial infection via the skin, also transmammary and placental infection occurs. Infects: dogs and cats Zoonosis : YES Diagonosis: larva in feces – NOT OVA Prepatent period: 8-14 days Treatment: Many anthelmintics kill adults Retreat every 7-10 days to prevent autoinfection
HEARTWORMS: Dirofilaria immitis Heartworm microfliaria in blood smear as seen under microscope	A nematode of dogs, cats, ferrets and potentially other animals which can result in heart failure. Adult heartworms are large 6+ inch worms of males and females that live and reproduce in the right side of the heart and pulmonary artery. The adults mate and the females releases embryos called microfilariae (above photos) into the blood, the pet is bitten by a mosquito and the microfilariae are picked up and develop into first stage larvae, the larvae molt twice and 3 rd stage larvae move to the mosquito’s mouth, upon the mosquito biting another pet the larvae are transferred and travel the pets body for ~6 months until they reach the heart and mature into adults ready for breeding. Diagnosis : ELISA Heartworm Ag test, Echocardiogram, Buffy coat examination, Blood Smear… Treatment: MELARSOMINE DIHYDROCHLORIDE (Immiticide) arsenic derivative Can be difficult, worms are killed but still have large adult worms in the heart Dead worms can block blood vessels of the lungs Given deeply in the muscle by injection over 1-2 days, t reated dogs are often confined Prevention : Easy and effective with many medications Heartgard: ivermection Revolution: selamectin

TREMATODES:

FLUKES

Many different species Are parasites of vertebrates or of mollusks Can occur in tissue and blood Dog – Salmon Poisoning Horses – Potomac Horse Fever Treamtment of Parasite – Praziquantal, Ivermectin Treatment of Disease – Specific to the disease, Doxycycline common

TAPEWORMS:

tapeworm ova as seen under microscope	1. Dipylidium caninum The common tapeworm of both dogs and cats, it lives in the small intestines. Are large worms of ~50cm in length, but cause little harm. No clinical signs may be noted. Diagnosis: usually via proglottids seen on the rectum Look like moving rice grains, Can do squash prep and examine for eggs under microscope Infection: typically from ingestion of fleas, so must also treat for fleas Treatment: Cestex, Droncit
Taenia ova as seen under scope	2. Taenia Taenia eggs can look similar to roundworm eggs but are much smaller in size. Also, note the thick, “striated” shell and several of the larval hooks which are seen in all tapes
	3. Echinococcus Potentially a dangerous zoonotic parasitic tapeworm that can produce hydatid cysts in humans, eggs are similar to taenia, infection is via a sheep, dog, human cycle

PROTOZOANS :

Coccidia seen under microscope - note very small	1. Coccidia isospora canis, isospora felis Common infection in young puppies and kittens, causes vomiting and diarrhea. These are very small organisms. May see with single circle in middle or sporulated (double). Prepatent Period is short: 7-14 days. Becomes infective after several days in the environment whey it sporulates.
	2. Toxoplasma gondii These are very small! The oocyst contains two sporocysts, each of which contain four sporozoites. Thus, they resemble the oocysts of Isospora but are much smaller. Only cats will produce and pass Toxoplasma oocysts in their feces. Zoonosis: Yes, potential cause of abortion in pregnant women Diagnosis: Fecal float and direct Avoidance: Don’t feed cats raw meat, wear gloves when gardening, clean litter box daily, pregnant women should avoid cleaning the litter box.
	3. Sarcocystis Intermediate host is a hoofed animal, and many species of reptiles, birds and vertebrates will serve as the definitive host
Giardia as seen unde microscope unstained	4. Giardia Cysts are passed in the feces of an infected host, and the next host is infected when it ingests cysts in food or water contaminated with feces. These cysts are resistant to environmental conditions. They are zoonotic, typically cause diarrhea, are very small and difficult to diagnose (see under microscope), ELISA snap test is available.

LINKS:

PN – highly recommended

http://www.vspn.org/

North American Vet Technician Association

http://www.navta.net/

VET TECH . com

http://www.vettech.com/

Bacteria names and grouping

http://www.dsmz.de/species/bacteria.htm

Guide to parasitic ova

http://www.cvm.okstate.edu/%7Eusers/jcfox/htdocs/clinpara/Index.htm

Veterinary Endoparasites – photos

http://cal.vet.upenn.edu/dxendopar/

Exotic DVM Home Page

http://www.exoticdvm.com/

Animal Insides: radiology

http://www.animalinsides.com/

Ophthalmology

http://www.vetmed.ucdavis.edu/courses/vet_eyes/default.html

Fungal Identification via microscopy

http://vtpb-www.cvm.tamu.edu/vtpb/vet_micro/charts_fungi/default.html

Radiographic Anatomy of Exotic Pets

http://cal.vet.upenn.edu/specrad/radiology/entrance.html

The virtual anesthesia machine

http://vam.anest.ufl.edu/

Avian/Exotic online class

http://www.spjc.edu/hec/vettech/VTDE/avian/7a.htm

Gillian’s Help Desk – toxicology

http://www.exoticbird.com/gillian/index.html

Enteral Nutrition Calculator

http://www.cvmbs.colostate.edu/clinsci/wing/enteral.html

Clinical Pathology Modules

http://web.vet.cornell.edu/public/popmed/clinpath/CPmodules/index.htm

Glossary of Veterinary Acronyms

http://www.spvs.org.uk/glossary.htm

Veterinary Terms

http://www.vetmed.wsu.edu/glossary/glossary.asp

CRI dosages Link:

http://www.cvmbs.colostate.edu/clinsci/wing/fluids/cri.htm

Poisonous Plants

http://www.ansci.cornell.edu/plants/index.html

Anesthesia: Go to documents

http://cvm.msu.edu/services/aneth/index.htm

Blood Collection Tubes – excellent site with specifics on collection.

http://www.austincc.edu/kotrla/phb_tubes or

http://www.saanendoah.com/vacutainerguide.html

E-Vet

http://www.e-vet.com/

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