Some Questions About Bloodwork And Urinalysis...

[Guest mgodwin]

Ginny recently had her first annual physical. The vet drew blood for CBC and Chem panel and had me collect a urine sample since she didn't want to give them one in the office. Overall, everything was pretty much normal except that her platelet count was low. When she called and left a voicemail all she said was that it was low but it may not be cause for concern. Since I had to drop off her urine sample this morning I picked up a copy of the lab results since I prefer quantitative descriptions over qualitative.

 

Looking at the report, her platelets were 17,000 but there was a note that indicated some clumping which may skew the results. Apparently the lab has a protocol that in situations like this, a tech will manually examine the sample. However, the description from the tech was qualitative and only said that it was decreased presumably relative to the reference range. As many of you know, that doesn't really mean much when we're talking about greyhounds.

 

After speaking to the vet, she said that given the presence of clumping, etc. she's not terribly concerned just yet but that if I wanted to bring her back in they would draw another sample and send it out free of charge. She also insisted that she be the one to draw the sample since there are some things that can be done during collection to minimize the possibility of clumping. So, since she was there today and I had the time I went home, grabbed Ginny, and we went back. It just so happens that her UA results were back when I was there.

 

Dr. Rice seemed rather impressed at just how clean it was since it was an at-home free catch sample and didn't comment on anything that was remarkable. However, she gave me a copy of the results and while everything looks just about perfect, I did notice that her protein was 1+ which is abnormal according to the reference. But the vet didn't seem concerned so I'm just curious if I'm overreacting. Should I be concerned about either of these results?

[MaryJane]

Next time make sure that you watch them draw the blood - if they do not transfer it quickly from the syringe to the tube with the anticoagulant, it could start clumping.

 

As to the urine, do you know what the specific gravity is? Next time bring in a first morning specimen as that gives you a better idea of the ability of the kidneys to concentrate the urine.

 

Protein should not be spilling out into the urine as this continuing could damage the filtration mechanism of the kidneys and result in even more protein spilling out. You may want to redo the test and see if it is still present. If there is an issue, look at the dog food that you are feeding as you might want to decrease the amount of protein (r provide better protein). There are dog foods that have about 19 to 20% protein and you could try that and see if the issue resolves.

 

FYI -- some would consider a small amount of protein OK ... I usually don't consider it normal especially if the bun/creat in the blood is high normal (to slight increase) and if the first morning specimen specific gravity is lower than 1.025. This could be an indication that the kidneys are having a hard time concentrating the urine and at the same time, are letting protein spill out. This is not a critical issue as it is easily controlled, I had a greyhound with some of these issues and he did fine on a low protein diet.

[tbhounds]

Greyhounds must be related to cats as they both like to clump their platelets. That said IMO a count of 17,000 is more then just clumping. That's a pretty darn low count and I'm surprised your vet dismissed it.

You absoultely need a re-draw and to save time automatically ask for a manual count. I would also run a 4dx test on the same sample. The 4dx is a tick borne disease/heartworm test. It's typically run in house and takes a whopping 8 minutes to receive results.

Regarding the urine--IMO there should never be protein present but, I understand many clinicians will dismiss smaller amounts. The +1 could potentially be from contaminant so yup, I would recheck the urine too.

[Guest mgodwin]

Thanks for the input MaryJane and tbhounds! I've got excellent news! After the re-draw Ginny's platelets were 156K. So it turns out there wasn't anything to get worked up over.

 

Next time make sure that you watch them draw the blood - if they do not transfer it quickly from the syringe to the tube with the anticoagulant, it could start clumping.

 

As to the urine, do you know what the specific gravity is? Next time bring in a first morning specimen as that gives you a better idea of the ability of the kidneys to concentrate the urine.

 

Protein should not be spilling out into the urine as this continuing could damage the filtration mechanism of the kidneys and result in even more protein spilling out. You may want to redo the test and see if it is still present. If there is an issue, look at the dog food that you are feeding as you might want to decrease the amount of protein (r provide better protein). There are dog foods that have about 19 to 20% protein and you could try that and see if the issue resolves.

 

FYI -- some would consider a small amount of protein OK ... I usually don't consider it normal especially if the bun/creat in the blood is high normal (to slight increase) and if the first morning specimen specific gravity is lower than 1.025. This could be an indication that the kidneys are having a hard time concentrating the urine and at the same time, are letting protein spill out. This is not a critical issue as it is easily controlled, I had a greyhound with some of these issues and he did fine on a low protein diet.

 

The urine sample I took in was a first of the morning sample and the specific gravity was 1.042. I asked the vet about the protein and she said that while there shouldn't really be any in the urine she's concentrating really well, maybe a little too well. She suggested that I monitor her water intake as she may be mildly dehydrated since her BUN was a little on the high side but not worrisome. She also asked about the protein in her diet. She's on TOTW which is pretty high in protein. She said I may want to consider switching to something lower in protein since she is technically considered a senior now.

 

Greyhounds must be related to cats as they both like to clump their platelets. That said IMO a count of 17,000 is more then just clumping. That's a pretty darn low count and I'm surprised your vet dismissed it.
You absoultely need a re-draw and to save time automatically ask for a manual count. I would also run a 4dx test on the same sample. The 4dx is a tick borne disease/heartworm test. It's typically run in house and takes a whopping 8 minutes to receive results.
Regarding the urine--IMO there should never be protein present but, I understand many clinicians will dismiss smaller amounts. The +1 could potentially be from contaminant so yup, I would recheck the urine too.

 

I wouldn't say she outright dismissed it but she wasn't overly concerned yet because of the clotting.

[tbhounds]

Phew-wonderful news. Regarding the +1 protein in the urine. It's a bit less concerning now that you mentioned her USG is 1.042. If you told me there was +1 protein in very dilute urine I would say that's cause for more concern.

[MaryJane]

Good news about the platelets!

 

As to the protein, there are a few TOTW products that have less protein - switch down to one with less % and retest urine in a few months and see if it made a difference. While occasionally having protein in the urine might not be concerning, it really is better (IMO) to not have any spilling out because as I mentioned earlier, it is damaging the filtration mechanisms as the protein continues to spill out.

[Guest mgodwin]

Phew-wonderful news. Regarding the +1 protein in the urine. It's a bit less concerning now that you mentioned her USG is 1.042. If you told me there was +1 protein in very dilute urine I would say that's cause for more concern.

 

That's essentially what the vet said. She said if she was having trouble concentrating and had protein in her urine she'd be concerned and want to run some more tests. But, since she's concentrating well there's no need to get too worked up about it.

 

Good news about the platelets!

 

As to the protein, there are a few TOTW products that have less protein - switch down to one with less % and retest urine in a few months and see if it made a difference. While occasionally having protein in the urine might not be concerning, it really is better (IMO) to not have any spilling out because as I mentioned earlier, it is damaging the filtration mechanisms as the protein continues to spill out.

 

Yeah, she's currently on the high prairie formula which has 32% protein. I was looking at some of the other varieties today and was considering either the Sierra Mountain or Pacific Stream formulas at 25% and 26% respectively. I'm leaning toward the Sierra Mountain formula since it's lamb instead of bison and venison. The High Prairie formula already has lamb meal in it so if she had a problem with lamb I might already be aware of it. I hope. The vet also mentioned re-checking her urine in a few months if I decide to change foods and see if that makes a difference.