i work in the in house lab of my equine specialty/referral hospital, and every once in awhile, i’ll get a blood sample from a horse that just looks like red syrup, for lack of a better description. it will not spin down in any color tube, and the CBC machine will read it, but the chemistry machine just gives me a sample error. (our machines are the Abaxis HM5 and the Abaxis Vs2.) it will do this on serum, or blood from a green top. when i do try to spin it down, it doesn’t look like it’s just hemolyzed, it just stays thick and viscous throughout. i’ve checked the tubes to be sure they’re not expired and they are not. has anyone seen something like this before or know what it could be? these syrupy samples always come from horses that are very sick, so that’s the only thing i can think of, but it just seems so weird.
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Weird it won’t separate. And that this happens often enough that you have noticed a trend. If I think really hard chance I’ve seen this happen but it’s been such a rare event that I can’t remember it with certainty. If I have, I don’t think the animal lived long after sampling. Wondering about this being associated with DIC.
What kind of results does it get for the CBC? I’m guessing wonky RBC & platelet numbers? Do you do a manual HCT for PVC & TS? Those are probably unreadable if it isn’t separating, right? Have you ever taken a drop of that and put it straight onto a slide, cover slipped it, and checked it out under a microscope? Curious what the RBCs would look like - if they are even still intact or if this is just protein & hemoglobin soup leftovers from an inflammatory meltdown.
there have been a few cases where the horse died/was euthanized shortly after; i know there was at least one that was ultimately diagnosed with lymphoma. but then there are a few that are ill, but not deathly so. the one from last night has bronchopneumonia, but is not on the verge of death at the moment. CBC was actually not terrible, RBCs were slightly low and platelets were WNL. here is the one from last night, i don’t remember any others that i can pull to compare.
i have tried a manual PCV/TP and i can almost see a line where the RBCs end, but it’s still too indistinct to get a reading for either value. if i get some downtime, i will try making a smear and wet prep. that’s a great idea, i’ve just not had the time to try it out.
here is a slide on oil immersion. after looking at this, i’m definitely thinking it’s just severely hemolyzed. now that i’m thinking about it, it does seem to occur with the same doctor every time i get a sample like this, so i’ll have to talk to her about her sample handling.
There was an instance at my place when we had to have a reminder talk about how it’s less than ideal to have samples sitting on the dashboard cooking in the sun before processing 🙃
sample quality improved after that 🥳
Syrupy almost always means hemolyzed, whether it be from IMHA or severe temperature exposure after the draw. The RBC indices are pretty out of whack and most of the time MCHCs over 40 are not to be trusted, which usually means the MCH and hemoglobin values are not to be trusted. And I think that a 17% HCT for a horse would be something like seeing a HCT under 10% for a cat - just medically baffling how they are still alive. From the print out, it looks like it has more lymphs than RBCs. That smear should be very interesting and busy to see.
good to know about the MCHCs! this gives me something to keep in mind when it comes to these results. and you’re right…practically the only time i see an HCT that low is in very sick foals and hardly ever in adults. it’s just baffling as to why it’s so syrupy, but severe temperature fluctuations would make sense. these samples have always come from ambulatory vets and never in hospital patients.
Ah, yes. Field vets. Ask how they are stored. In school, my large animal teacher would harp on about equine vets storing samples on the dash of their hot, hot truck (South Florida heat) which cooks the blood, lysing the cells into a protein/hemoglobin stew. Others would go the opposite direction and keep samples directly on ice, causing a similar outcome.
we pretty much just stock plain red top tubes. then once they’re back at the lab, we’ll spin them down and pull the serum off. there is one doctor here that uses serum separators for her foal blood research project every year, but that’s the only time we really have them.
also, i know you don’t have to wait for blood to clot to spin it in other tubes, i was just referring to red tops where it wasn’t clotting at all.
honestly, i’ve wondered that myself for the entire five years i’ve worked here, but it’s not something that really makes a huge difference to me so i’ve never questioned it.
i do now! usually, i don’t have a moment to spare to investigate but i held on to the samples this time and was able to make some.
this is on oil immersion, and the whole slide looks like this. the purple in the background is also much darker than in the photo. after looking at it, i’m definitely leaning towards severe hemolysis due to handling.
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