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Low-Cost Veterinary Clinical Diagnostics

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Low-Cost Veterinary Clinical Diagnostics

A practical guide to maximizing the diagnostic value of in-house quick assessment tests (QATs)

In Low-Cost Veterinary Clinical Diagnostics, the authors provide a hands-on resource designed to facilitate healthcare delivery across the spectrum of care.

Historically, clinicians have been taught to apply the gold standard approach to the practice of medicine. However, recent advances in veterinary medical care and associated technologies have made practitioners question whether a one-size-fits-all approach is truly best. After all, when we perform diagnostic tests, are we testing out of the desire for completeness, to cover all bases for the good of the patient? Or are we testing because we are expected to?

The reality is that gold standard care is not always advisable and not always possible. In clinical practice, veterinarians frequently encounter obstacles that limit their approaches to case management. Cost of care is a significant constraint that requires practitioners to rethink which diagnostic tests are essential.

Not every patient requires a complete blood count (CBC), chemistry profile, urinalysis, and fecal analysis to obtain diagnostic value. This text suggests that the “best” approach to case management be determined by the situation, the context, the patient, and the client.

While sophisticated panels of tests may remain the recommended approach to case management, Low-Cost Veterinary Clinical Diagnostics outlines entry-level, in-house diagnostic blood, urine, fecal, and body cavity fluid tests: how to perform them as well as the breadth and depth of patient-specific data that can be gleaned from quick assessment tests (QATs).

Readers will also find:

  • A thorough introduction to patient care considerations, communication strategies that facilitate cost-conscious shared decision-making
  • Comprehensive explorations of quick assessment tests (QATs) in hematology, including packed cell volume (PCV), total solids (TS), buffy coat analysis, blood smears, blood glucose, blood urea nitrogen (BUN), saline agglutination tests, and activated clotting time.
  • Practical discussions of quick assessment tests (QATs) involving urine, including urine color, dipstick analysis, specific gravity (USG), and urine sediment analysis
  • Pragmatic evaluation of fecal analysis, including considerations surrounding fecal color, volume, consistency, and odor; saline smears or wet mounts, and fecal flotation.
  • Discussion on body cavity fluid analysis
  • Sample case vignettes, complete with question and answer (Q&A)

Perfect for veterinary practitioners, veterinary technicians, veterinary and veterinary technician students, Low-Cost Veterinary Clinical Diagnostics offers a quick and easy reference guide to maximizing diagnostic value in those cases where care is cost-prohibitive.

Author(s): Ryane E. Englar, Sharon Dial
Publisher: Wiley-Blackwell
Year: 2023

Language: English
Pages: 365
City: Hoboken

Cover
Title Page
Copyright Page
Dedication
Contents
About the Authors
About the Contributors
Preface
Acknowledgments
Part 1 Patient Care Considerations
Chapter 1 The Gold Standard, Standards of Care, and Spectrum of Care: An Evolving Approach to Diagnostic Medicine
1.1 Defining the Gold Standard
1.2 Limitations of the Gold Standard
1.3 Returning to the Case of the Cat with Stranguria: a Different Perspective on Standards of Care
1.4 Limitations to Standards of Care
1.5 Spectrum of Care
References
Chapter 2 Consultation Room Communication Strategies that Facilitate Dialogue on the Diagnostic Approach to Patient Care
2.1 Emergence of Communication as a Clinically Relevant Skill in Human Health Care
2.2 The Evolution of Communication in Veterinary Health Care
2.3 Communication Skills That Are Essential to Diagnosis-Making
2.4 Concepts of Health Literacy and Compliance
2.5 Using Easy-to-Understand (Nonmedical) Language
2.6 Checking in
2.7 Assessing the Client’s Knowledge
2.8 Signposting
2.9 Addressing the Cost of Care
References
Part 2 Quick Assessment Tests (QATS) Involving Blood
Chapter 3 Packed Cell Volume
3.1 Procedural Definition: What Is this Test About?
3.2 Procedural Purpose: Why Should I Perform this Test?
3.3 Equipment
3.4 Procedural Steps: How Do I Perform this Test?
3.5 Time Estimate to Perform Test
3.6 Procedural Tips and Troubleshooting
3.7 Interpreting Test Results
3.8 Clinical Case Example(s): Can We Link to the Cases in Chapter 5?
3.9 Add-On Tests That You May Need to Consider and Their Additive Value
3.10 Key Takeaways
References
Chapter 4 Total Protein as Measured by Refractometry
4.1 Procedural Definition: What Is This Test About?
4.2 Procedural Purpose: Why Should I Perform this Test?
4.3 Equipment
4.4 Procedural Steps: How Do I Perform this Test?
4.5 Time Estimate to Perform Test
4.6 Procedural Tips and Troubleshooting
4.7 Interpreting Test Result
4.8 Clinical Case Example(s)
4.9 Add-On Tests That You May Need to Consider and Their Additive Values
4.10 Key Takeaways
Reference
Suggested References
Chapter 5 Gross and Microscopic Evaluation of the Buffy Coat
5.1 Procedural Definition: What Is This Test About?
5.2 Procedural Purpose: Why Should I Perform this Test?
5.3 Equipment
5.4 Procedural Steps: How Do I Perform this Test?
5.5 Time Estimate to Perform Test
5.6 Procedural Tips and Troubleshooting
5.7 Interpreting Test Results
5.8 Clinical Case Example(s)
5.9 Add-On Tests That You May Need to Consider and Their Additive Value
5.10 Key Takeaways
Reference
Chapter 6 The Blood Film
6.1 Procedural Definition: What Is This Test About?
6.2 Procedural Purpose: Why Should I Perform This Test?
6.3 Equipment
6.4 Procedural Steps: Preparing the Blood Film How Do I Perform This Test?
6.4.1 Procedure
6.4.2 Evaluating the Blood Film
6.4.3 Gross Examination of the Blood Film
6.4.4 Microscopic Examination of the Blood Film
6.5 Time Estimate to Perform Test
6.6 Procedural Tips and Troubleshooting
6.7 Interpreting Test Results
6.8 Clinical Case Example(s)
6.9 Add-On Tests That You May Need to Consider and Their Additive Value
6.10 Key Takeaways
References
Suggested Bench-Side Reference
Chapter 7 Blood Glucose
7.1 Procedural Definition: What Is This Test About?
7.2 Procedural Purpose: Why Should I Perform This Test?
7.3 Equipment
7.4 Procedural Steps: How Do I Perform This Test?
7.5 A Note on Quality Control
7.6 Procedure for Patient Samples
7.7 Time Estimate to Perform Test
7.8 Procedural Tips and Troubleshooting
7.9 Interpreting Test Results
7.10 Clinical Case Example(s)
7.11 Add-On Tests That you May Need to Consider and Their Additive Values
7.12 Key Takeaways
References
Chapter 8 Blood Urea Nitrogen
8.1 Procedural Definition: What Is This Test About?
8.2 Procedural Purpose: Why Should I Perform This Test?
8.3 Equipment
8.4 Procedural Steps: How Do I Perform this Test?
8.5 Time Estimate to Perform Test
8.6 Procedural Tips and Troubleshooting
8.7 Interpreting Test Results
8.8 Clinical Case Example(s)
8.9 Add-On Tests That You May Need to Consider and Their Additive Value
8.10 Key Takeaways
Chapter 9 Whole Blood Lactate
9.1 Procedural Definition: What Is This Test About?
9.2 Procedural Purpose: Why Should I Perform This Test?
9.3 Equipment
9.4 Procedural Steps: How Do I Perform This Test?
9.5 A Note on Quality Control
9.6 Procedure for Patient Samples
9.7 Time Estimate to Perform Test
9.8 Procedural Tips and Troubleshooting
9.9 Interpreting Test Results
9.10 Clinical Case Example(s)
9.11 Add-On Tests That You May Need to Consider and Their Additive Value
9.12 Key Takeaways
References
Chapter 10 Saline Agglutination Test
10.1 Procedural Definition: What Is This Test About?
10.2 Procedural Purpose: Why Should I Perform This Test?
10.3 Equipment
10.4 Procedural Steps: How Do I Perform This Test?
10.4.1 Quick slide method
10.5 Time Estimate to Perform Test
10.6 Procedural Tips and Troubleshooting
10.7 Interpreting Test Results
10.8 Clinical Case Example(s)
10.9 Add-On Tests That You May Need to Consider and Their Additive Value
10.10 Key Takeaways
Reference
Chapter 11 Activated Clotting Time
11.1 Procedural Definition: (“What Is This Test About?”)
11.2 Procedural Purpose: Why Should I Perform This Test?
11.3 Equipment
11.4 Procedural Steps: How Do I Perform This Test?
11.5 Time Estimate To Perform Test
11.6 Procedural Tips and Troubleshooting
11.7 Interpreting Test Results
11.8 Clinical Case Example(s)
11.9 Add-On Tests That You May Need to Consider and Their Additive Value
11.10 Key Takeaways
Part 3 Quick Assessment Tests (QATS) Involving Urine
Chapter 12 Assessing Urine’s Physical Properties
12.1 Procedural Definition: What Is This Test About?
12.2 Procedural Purpose: Why Should I Perform This Test?
12.2.1 Sample Volume
12.2.2 Sample Color
12.2.3 Sample Clarity
12.2.4 Sample Odor
12.3 Equipment
12.4 Procedural Steps
12.5 Time Estimate to Perform Test
12.6 Procedural Tips and Troubleshooting
12.6.1 Urine Collection
12.6.2 Urine Color
12.6.3 Urine Turbidity
12.7 Interpreting Test Results
12.7.1 Sample Color
12.7.2 Sample Turbidity
12.7.3 Sample Odor
12.8 Clinical Case Example(s)
12.9 Add-On Tests That You May Need to Consider and Their Additive Value
12.10 Key Takeaways
12.11 Clinical Pearls
References
Chapter 13 Urine Specific Gravity
13.1 Procedural Definition: What Is This Test About?
13.2 Procedural Purpose: Why Should I Perform this Test?
13.3 Equipment
13.4 Procedural Steps
13.5 Time Estimate to Perform Test
13.6 Procedural Tips and Troubleshooting
13.6.1 Tips
13.6.2 Difficulties Reading the UG or SG Scale
13.6.3 Unusual Results
13.7 Interpreting Test Results
13.8 Clinical Case Example(s)
13.9 Add-On Tests That You May Need to Consider and Their Additive Value
13.10 Key Takeaways
13.11 Clinical Pearls
References
Chapter 14 Chemical Evaluation of Urine: Urine Dipstick Analysis
14.1 Procedural Definition: What Is This Test About?
14.2 Procedural Purpose: Why Should I Perform This Test?
14.3 Equipment
14.4 Procedural Steps
14.5 Time Estimate to Perform Test
14.6 Procedural Tips and Troubleshooting
14.6.1 Regarding the Urine Sample
14.6.2 Regarding the Test Strips
14.6.3 Regarding the Procedure
14.6.4 Regarding Color Change Interpretations
14.7 Interpreting Test Results
14.7.1 For Glucose
14.7.2 Bilirubin
14.7.3 Ketones
14.7.4 Occult Blood (Heme)
14.7.5 pH
14.7.6 Protein
14.8 Clinical Case Example(s)
14.9 Add-On Tests That You May Need to Consider and Their Additive Value
14.9.1 Improving the Accuracy of Data Concerning the Sample’s Glucose
14.9.2 Improving the Accuracy of Data Concerning the Presence or Absence of Ketones
14.9.3 Distinguishing Hematuria, Hemoglobinuria, and Myoglobinuria if the Occult Blood (Heme) Tests Positive
14.9.4 Improving the Accuracy of Data Concerning the Sample’s pH
14.9.5 Improving the Accuracy of Data Concerning Proteinuria
14.10 Key Takeaways
14.11 Clinical Pearls
14.11.1 Regarding Glucosuria
14.11.2 Regarding Bilirubinuria
14.11.3 Regarding the Impact of Urine pH on the Sediment
14.11.4 Proteinuria
14.11.5 Other
References
Chapter 15 Urine Sediment Examination
15.1 Procedural Definition: What Is This Test About?
15.2 Procedural Purpose: Why Should I Perform This Test?
15.3 Equipment
15.4 Procedural Steps: How Do I Perform This Test?
15.5 Time Estimate to Perform Test
15.6 Procedural Tips and Troubleshooting
15.7 Interpreting Test Results
15.7.1 Cellular Element: Erythrocytes, Leukocytes, Epithelial Cells
15.7.2 Casts: Hyaline Casts, Granular Casts, Cellular Casts, Waxy Casts
15.7.3 Crystals: Ammonium Biurates, Bilirubin, Calcium Oxalate, Cystine, Struvite, Tyrosine, Uric Acid
15.7.4 Microorganisms
15.8 Clinical Case Example(s)
15.9 Add-On Tests That You May Need to Consider and Their Additive Value
15.10 Key Takeaways
Reference
Suggested Bench-Side References
Part 4 Quick Assessment Tests (QATS) Involving Feces
Chapter 16 Assessing the Physical Properties of Fecal Matter
16.1 Procedural Definition: What Is This Test About?
16.2 Procedural Purpose: Why Should I Perform This Test?
16.2.1 Sample Consistency
16.2.2 Sample Color
16.2.3 Presence/Absence of Blood
16.2.4 Presence/Absence of Mucous Coating
16.2.5 Presence/Absence of Gross Parasitism and Other “Content”
16.2.6 Sample Odor
16.3 Equipment
16.4 Procedural Steps
16.5 Time Estimate to Perform Test
16.6 Procedural Tips and Troubleshooting
16.6.1 Patient-Specific Considerations: Important Clues from History-Taking
16.6.2 Patient-Specific Considerations: Important Clues from Physical Examination
16.6.3 Sample Collection
16.6.4 Sample Collection Containers
16.6.5 Sample Size
16.6.6 Age of Sample
16.7 Interpreting Test Results
16.7.1 Fecal Consistency
16.7.2 Fecal Color
16.7.3 Presence/Absence of Blood
16.7.4 Presence/Absence of Mucus
16.7.5 Gross Parasitism
16.7.6 Odor
16.8 Clinical Case Example(s)
16.9 Add-On Tests That You May Need to Consider and Their Additive Value
16.10 Key Takeaways
16.11 Clinical Pearls
References
Chapter 17 Direct Smears
17.1 Procedural Definition: What Is This Test About?
17.2 Procedural Purpose: Why Should I Perform This Test?
17.2.1 The Rationale for Employing Wet Mounts to Diagnose Giardiasis
17.2.2 The Rationale for Employing Wet Mounts to Diagnose Trichomoniasis
17.2.3 The Rationale for Employing Wet Mounts to Diagnose Campylobacter spp.
17.3 Equipment
17.4 Procedural Steps [1–5, 20, 30, 60–62]
17.5 Time Estimate to Perform Test
17.6 Procedural Tips and Troubleshooting
17.7 Interpreting Test Results
17.8 Clinical Case Example(s)
17.9 Add-On Tests That You May Need to Consider and Their Additive Value
17.9.1 The Rationale for Fecal Flotation as an Add-On Diagnostic Test
17.9.2 The Rationale for Giardia Antigen Detection Tests an Add-on Diagnostic Tool
17.9.3 The Rationale for Add-On Diagnostic Tests for Detection of Tritrichomonas Foetus
17.9.4 The Rationale for Dry Mount Fecal Cytology as an Add-On Diagnostic Tool
17.10 Key Takeaways
17.11 Clinical Pearls
References
Chapter 18 Fecal Flotation
18.1 Procedural Definition: Whatis This Test About?
18.2 Procedural Purpose: Why Should I Perform This Test?
18.3 Options Available for Fecal Flotation
18.4 Equipment
18.5 Procedural Steps: Fecal Flotation with Fixed-Angle Centrifuge[1–4, 8, 11, 22, 23, 28]
18.6 Time Estimate to Perform Fecal Flotation with Fixed-Angle Centrifuge
18.7 Brief Consideration of the Procedural Steps in the Event a Swinging Bucket Centrifuge Is Used
18.8 Equipment
18.9 Procedural Steps
18.10 Time Estimate to Perform Passive Fecal Flotation
18.11 Procedural Tips and Troubleshooting for Fecal Flotation
18.12 Interpreting Test Results
18.12.1 Ascarids (Roundworms)
18.12.2 Hookworms
18.12.3 Tapeworms
18.12.4 Whipworms
18.12.5 Protozoa
18.13 Clinical Case Example(s)
18.14 Add-On Tests That You May Need to Consider and Their Additive Value
18.14.1 The Rationale for History-Taking as an Add-On Diagnostic Tool
18.14.2 The Rationale for the Direct Smear as an Add-On Diagnostic Tool
18.14.3 The Rationale for Giardia Antigen Detection Tests as an Add-On Diagnostic Tool
18.14.4 The Rationale for CBC and Blood Chemistry Profile Tests as Add-On Diagnostic Tools
18.14.5 The Rationale for the Baermann Test as an Add-On Diagnostic Tool
18.15 Key Takeaways
18.16 Clinical Pearls
References
Part 5 Quick Assessment of Body Cavity Fluids
Chapter 19 Body Cavity Fluid Analysis
19.1 Procedural Definition: What Is This Test About?
19.2 Procedural Purpose: Why Should I Perform This Test?
19.3 Equipment
19.4 Procedural Steps: How Do I Perform This Test?
19.5 Time Estimate to Perform Test
19.6 Procedural Tips and Troubleshooting
19.7 Interpreting Test Results
19.7.1 Transudates
19.7.2 High-Protein/Protein-Rich Effusions
19.7.3 Inflammatory Exudates
19.7.4 Hemorrhagic Effusions
19.7.5 Chylous and Lymphocytic Effusions
19.7.6 Neoplastic Effusions
19.8 Clinical Case Example(s)
19.9 Add-On Tests That You May Need to Consider and Their Additive Value
19.10 Key Takeaways
References
Suggested Bench-Side References
Part 6 Clinical Cases
Chapter 20 Clinical Cases
1 Case #1
1.1 Signalment
1.2 History
1.3 Presentation
1.4 Physical Exam Findings
2 Case #2
2.1 Signalment
2.2 History
2.3 Presentation
2.4 Physical Exam Findings
3 Case #3
3.1 Signalment
3.2 History
3.3 Presentation
3.4 Physical Exam Findings
3.5 Follow-Up Physical Exam Findings
4 Case #4
4.1 Signalment
4.2 History
4.3 Presentation
4.4 Physical Exam Findings
5 Case #5
5.1 Signalment
5.2 History
5.3 Presentation
5.4 Physical Exam Findings
6 Case #6
6.1 Signalment
6.2 History
6.3 Presentation
6.4 Physical Exam Findings
7 Case #7
7.1 Signalment
7.2 History
7.3 Presentation
7.4 Physical Exam Findings
8 Case #8
8.1 Signalment
8.2 History
8.3 Presentation
8.4 Physical Exam Findings
9 Case #9
9.1 Signalment
9.2 History
9.3 Presentation
9.4 Physical Exam Findings
10 Case #10
10.1 Signalment
10.2 History
10.3 Presentation
10.4 Physical Exam Findings
11 Case #11
11.1 Signalment
11.2 History
11.3 Presentation
11.4 Physical Exam Findings
12 Case #12
12.1 Signalment
12.2 History
12.3 Presentation
12.4 Physical Exam Findings
13 Case #13
13.1 Signalment
13.2 History
13.3 Presentation
13.4 Physical Exam Findings
14 Case #14
14.1 Signalment
14.2 History
14.3 Presentation
14.4 Physical Exam Findings
15 Case #15
15.1 Signalment
15.2 History
15.3 Presentation
15.4 Physical Exam Findings
References
Index
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