Veterinary Clinical Pathology Research Articles

Reference Intervals (RIs) in veterinary medicine

Reference Intervals (RIs) are necessary in veterinary clinical pathology to provide a data base in order to compare results obtained from healthy versus diseased animals. Data are obtained from laboratory tests and, depending on whether they have a Gaussian or non-Gaussian distribution, are processed through statistical tests to define the RIs. This process begins with a healthy reference population made up of individuals who have been initially chosen based on inclusion or exclusion criteria. It is frequently challenging to have a large number of healthy individuals on which to establish de novo RIs, especially in wild and exotic animals. However, the use of reference intervals in daily clinical practice remains a fundamental instrument for therapeutic and diagnostic decisions, but it must always be accompanied by clinical findings that can confirm the hypothesis.

The American Society of Veterinary Clinical Pathology (ASVCP) 57th Annual Meeting in conjunction with the American College of Veterinary Pathology (ACVP) 72th Annual Meeting, Chicago, Illinois, USA-October 28-31, 2023.

The American Society of Veterinary Clinical Pathology (ASVCP) 57th Annual Meeting in conjunction with the American College of Veterinary Pathology (ACVP) 72th Annual Meeting, Chicago, Illinois, USA-October 28-31, 2023.

Development of reference intervals for serum biochemistry and haematology of juvenile green sea turtles (Chelonia mydas) in a Thai rehabilitation centre.

No reference intervals for serum biochemistry and haematology of sea turtles in Thailand exists to assist veterinarians who are responsible for sea turtle health management and treatment. This study determined serum biochemistry and basic haematology of healthy juvenile green sea turtles (n = 92) in captivity in Thailand following the American Society for Veterinary Clinical Pathology (ASVCP), Quality Assurance and Laboratory Standards Committee (QALS) guidelines for the determination of reference intervals in veterinary species. Biochemistry tests, including blood urea nitrogen, creatinine, uric acid, alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase were analysed using an IDEXX VetTest Chemistry Analyzer. Haematology parameters were measured manually using a microhaematocrit for packed cell volume (PCV), Neubauer counting chamber for red blood cell count and cyanmethemoglobin method for haemoglobin concentration. mean corpuscular volume and mean corpuscular haemoglobin concentration were calculated using the PCV, red blood cell count and haemoglobin. Turtles in this study were found to have higher mean values for PCV (28.70%), haemoglobin (92.13 g/L), mean corpuscular haemoglobin concentration (327.03 g/L), uric acid (247.15 μmol/L), alanine aminotransferase (16.53 IU/L), aspartate aminotransferase (209.44 IU/L), and alkaline phosphatase (245.08 IU/L) compared to sea turtles in Brazil. The reference intervals established using high numbers of healthy turtles in this study will assist veterinarians with diagnostic and treatment decisions when evaluating laboratory results for juvenile green sea turtles.

Analytical performance of feline plasma on current Heska and IDEXX point-of-care biochemistry analyzers compared with a commercial laboratory analyzer.

Point-of-care (POC) biochemistry analyzers are widely used in small animal clinical practice but infrequently independently assessed for performance. To assess the performance of two current model point-of-care biochemistry analyzers (Heska Element DC and IDEXX Catalyst) compared with a commercial laboratory analyzer (Cobas 8000). One hundred twenty-one cats from a feline hospital population were sampled with plasma results from a single lithium heparin tube assessed on all three analyzers. Plasma biochemistry results from each POC analyzer were compared with the commercial laboratory analyzer using Bland-Altman difference plots and by determining whether the limits of agreement (LOAs) (95% of differences) fell within various quality goals after correcting for inherent bias. Only 7 of 14 analytes on the Heska analyzer and 2 analytes on the IDEXX analyzer attained the most stringent LOA quality goal, which was being within desirable total error based on biologic variation (TEdes ). The number of analytes achieving quality goals increased with less stringent standards such as American Society of Veterinary Clinical Pathologists allowable total error (ASVCP TEA ) guidelines or if <95% of clinical comparisons reaching these quality goals is considered acceptable. Widespread bias was found between both POC analyzers and the commercial laboratory analyzer. The performance of both POC biochemistry analyzers was variable compared with a commercial laboratory analyzer. Performance goals were only able to be attained after the bias for each analyzer was accounted for by offsetting the LOAs and quality goals set by the mean bias for each analyte on each analyzer.

Development of a reference interval for urinary ammonia-to-creatinine ratio in feline patients.

Disruption of acid-base homeostasis can lead to many clinical problems. Ammonia excretion by the kidneys is critical to maintaining acid-base homeostasis through bicarbonate production. Measurement of ammonia excretion may help determine if the kidneys are properly functioning in maintaining acid-base balance. Reference intervals are essential tools for clinical decision-making but do not currently exist for urinary ammonia-to-creatinine ratio (UACR) in feline patients. This study aimed to generate a reference interval (RI) for UACR in healthy adult cats. The study used samples from client-owned adult healthy cats that presented to the University of Florida Primary Care and Dentistry service (n = 92). Physical examination, serum biochemistry, urinalysis, urine ammonia, and creatinine concentrations were measured. Cats were excluded if there were significant abnormalities in their urinalysis or biochemistry panel. The RI for UACR was calculated according to the recommendation of the American Society for Veterinary Clinical Pathology. The UACR was evaluated for correlation with serum bicarbonate, weight, age, and sex. The RI for UACR was 3.4-20.7 with 90% confidence intervals for the lower and upper limits of (3.0-3.7) and (16.0-23.7), respectively. No significant correlation with age, sex, or weight was found. There was no discernable relationship between serum bicarbonate and UACR. Establishing an RI for UACR in healthy adult cats will allow further studies to determine if changes in UACR are observed during specific disease states.

Veterinary clinicians prefer template-style reports with personal confidence estimates for cytologic sample evaluations.

To examine preferences of veterinary clinical pathologists, clinicians, and students for cytology report formats. 24 clinical pathologists, 1,014 veterinarians, and 93 veterinary students who were members of the Veterinary Information Network. Members of the Veterinary Information Network responded to an online survey invitation, made available between July 11, 2023, and July 24, 2023. Respondents were randomly directed to 1 of 4 sets of cytology reports, each containing a traditional narrative format, narrative format with terms expressing a degree of confidence and associated numerical ranges, and template format with similar estimates of confidence. Respondents ranked the reports in order of preference and then provided comments about their top-ranked choice. Responses were analyzed mostly with descriptive statistics or comparisons of proportions. 14 of 24 clinical pathologists preferred the traditional narrative format, whereas 449 of 1,042 veterinary clinicians and veterinary students preferred the template format. Respondents (460/1,131) ranked the template format as most preferred, but the narrative format with terms expressing a degree of confidence ranked highest overall. Many respondents appeared to misunderstand the degree of confidence estimates being expressed numerically. Respondents choosing each format often stated that their preferred choice was "easiest to understand" and "most comprehensive." Given the preferences of veterinary clinicians and veterinary students for a template format, clinical pathologists should consider modifying the way they report evaluations of cytologic specimens. Template formats should help standardize reporting of cytologic specimens, thereby improving communication between clinical pathologists and clinicians. However, both clinicians and clinical pathologists need to better understand the purpose of terminology expressing degrees of confidence in such reports.

Analytical Validation of MINI-PET as Point-of-Care for Erythrocyte Sedimentation Rate Measure in Horses.

The erythrocyte sedimentation rate (ESR) is a widely used diagnostic assay in human medicine but nowadays poorly applied in veterinary medicine. This test measures the speed (millimeters per hour) at which red blood cells settle in a whole anticoagulated blood tube. In human medicine, high ESR values are associated with various disorders, including infections, rheumatoid arthritis, oncologic diseases, and other inflammatory conditions. The ESR can also be influenced by some factors such as age and gender. In veterinary medicine, the ESR with the Westergren manual method was almost forgotten over the years due to blood consumption and long turn-around time. The instrument MINI-PET, using a modified Westergren method, does not require blood consumption or release waste product and recently has been applied in canine medicine. The aims of the study in the horse were as follows: to establish the appropriate time to read the ESR with the Westergren reference method; to compare the MINI-PET ESR results with the reference technique; to assess the ESR reference intervals with MINI-PET; and to establish the ESR stability from collection at different time points by MINI-PET. Using 150 horses, we established 60 minutes as the appropriate time for ESR reading with the Westergren method. Moreover, ESR results obtained in 8 minutes with MINI-PET showed a good correlation with the Westergren ESR. Reference intervals (RIs) with MINI-PET were established in mm/h for the healthy horses (geldings 18.6-100.1; stallions, 13.8-55.7; and mares 1-73.7) according to the American Society of Veterinary Clinical Pathology guidelines. In addition, the ESR stability from the blood collection time was evaluated in the MINI-PET on 15 horses: at room temperature, ESR is stable up to 8 hours and at 4°C up to 24 hours. In conclusion, MINI-PET represents a rapid and reliable tool for measuring ESR in horses, offering a valid option to replace the traditional manual technique.

Determination of age-specific reference intervals for selected serum and urinary biomarkers in elderly cats.

Annual health screening is recommended in elderly cats to allow the early detection of conditions such as chronic kidney disease (CKD) and hyperthyroidism. Nevertheless, age-specific reference intervals (RIs) for renal and thyroid parameters in this population are lacking. The aim of this study was to determine age-specific RIs for selected serum and urine biomarkers related to CKD and hyperthyroidism, namely serum creatinine (sCr), symmetric dimethylarginine (SDMA), phosphate (P), total calcium (tCa), total thyroxine (TT4), urinary protein:creatinine ratio (UPC) and urine specific gravity (USG). These RIs were established for elderly cats (aged ⩾7 years) in general, as well as for mature adult cats (aged 7-10 years) and senior cats (aged >10 years) separately. A prospective study was conducted on client-owned cats aged ⩾7 years and considered healthy by their owners. The cats were screened to rule out metabolic and systemic diseases by means of a thorough history, complete physical examination, blood examination and urinalysis. The data from 206 healthy elderly cats (134 mature adult and 72 senior cats) were included. Age-appropriate RIs were determined following the guidelines of the American Society of Veterinary Clinical Pathology and compared with existing laboratory RIs. Clinically relevant differences between the age-specific RI and the laboratory RI were found for several variables. Compared with the laboratory RI, the upper limit of the RI for cats aged ⩾7 years was lower for sCr, TT4 and P, and higher for SDMA. The lower limit of the age-appropriate RI was lower for USG. The new RI was almost identical to the existing laboratory RI for tCa and UPC. Using age-specific RIs for renal and thyroid biomarkers in mature adult and senior cats has important clinical consequences for the interpretation of health screening results in elderly cats. This confirms the need to adapt laboratory RIs to the specific animal population for which the RI will be used.

Establishing hematologic and biochemical reference intervals for the endangered Lear's macaw (Anodorhynchus leari).

The Lear's macaw, Anodorhynchus leari (Psittaciformes, Psittacidae), is an endemic species of the Caatinga region in Brazil. With only a few free-living individuals that are constantly under threat from agricultural clearance, hunting, and trapping, A. leari is classified as "endangered" by the Red Book of Endangered Brazilian Fauna and by the International Union for Conservation of Nature. At the same time, the number of individuals in captivity has been growing due to the efforts of biologists and veterinarians in zoological parks to reproduce this species. Thus, having species-specific reference intervals for hematologic and biochemical measurands is essential to assess the health status of these captive and wild birds and guarantee their reproductive success. This study aimed to determine reference intervals for hematologic and biochemical measurands for A. leari kept in captivity in São Paulo Zoo, Brazil. Blood samples from 32 individuals were selected based on inclusion and exclusion criteria. Only samples from adults and healthy individuals were included in this study. All statistical analyses were performed according to the American Society for Veterinary Clinical Pathology guidelines and available literature. Reference values and reference intervals were determined for the captive population of Anodorhynchus leari. This is the first study to establish reference intervals for A. leari, which can aid the veterinarian in the interpretation of laboratory test results, helping in the diagnosis, treatment, and monitoring of diseases of this endangered species of Brazilian fauna.

FREE-RANGING OCELOTS (LEOPARDUS PARDALIS): HEMATOLOGY AND SERUM CHEMISTRY REFERENCE VALUES.

Acquiring baseline physiologic data for animals from a free-ranging wildlife species is an elusive objective. Between 1990 and 2020, a monitoring program on the last population of ocelot (Leopardus pardalis) to inhabit public land in the United States yielded 139 blood samples from 67 individual animals. Ocelots were live trapped and anesthetized for census and radiotelemetric studies. The protocol included morphometrics, photographs, electronic identification, and blood collection. Complete blood count and serum chemistry were performed, and after sorting of the data to remove unhealthy individuals and occasional outliers, the dataset provided sufficient information to compute reliable reference intervals (RI). According to the American Society of Veterinary Clinical Pathology consensus guidelines, RI should be elaborated by using data from each reference individual only once. RI by random selection was determined when several measurements were available over time from one same animal. Second, RI were also computed allowing repeat measurements for reference individuals, exclusively to characterize and quantify the effect on the data distribution and on the generated RI. A summary of published RI for various species of wild felids is also presented. The variations observed between species is due not only to species differences but also to variation in measurement methods and RI study design. Overall, accurate blood work interpretation requires RI generated from a healthy population, with defined measurement methods and state-of-the-art RI study design. Of note, calcium is typically tightly regulated in all mammals, as illustrated by the narrow RI (8.5-10.8 mg/dl); conversely, finding a narrow RI in calcium across as many as 49 healthy individuals suggests a high-quality design study.

Diagnostic quality of ultrasound-guided fine-needle aspirates samples from the canine liver and spleen is not significantly affected by using 22-, 23-, and 25-gauge needles.

Ultrasound-guided fine-needle aspirates (FNA) of the liver and spleen for cytological analysis are a commonly performed procedure in canine veterinary practice. Based on our review of the literature, this is the first published study investigating whether needle size affects the diagnostic quality of hepatic and splenic samples. The aim of this prospective analytical study was to compare the diagnostic quality of ultrasound-guided FNA cytological samples of canine liver and spleen based on cellularity, blood contamination, and overall cell preservation between three different needle sizes (22-, 23-, and 25-gauge). A total of 282 splenic aspirates from 94 dogs and 348 hepatic aspirates from 116 dogs were enrolled in the study and examined by two board-certified veterinary clinical pathologists. In this study, no significant differences in diagnostic quality were identified between different needle gauge sizes when sampling canine liver and spleen. Blood contamination was higher using 22-gauge needles compared with 25-gauge needles (P=0.024) when sampling the liver.

Establishment of a reference interval for 12-hour fasted serum gastrin concentration in adult dogs.

Adherence to traditional 24-h fasting periods for serum gastrin concentration in dogs can be challenging and may delay the institution of therapies for suspected hypergastrinemia. Peer-reviewed publications regarding serum gastrin reference intervals (RI) are lacking. Hypercalcemia is associated with hypergastrinemia in people; limited data exist in dogs. The objective of the study was to generate a RI for a 12-h fasted serum gastrin concentration in dogs and to investigate whether correlations exist with age, weight, sex, and total calcium concentration. Fifty-five healthy adult dogs (>1 year of age). The screening included: medical history, physical examination, CBC (15 dogs), and serum chemistry (55 dogs). Gastrin was measured via a commercial radioimmunoassay. The RI for 12-h fasted serum gastrin concentration was calculated according to the recommendations of the American Society for Veterinary Clinical Pathology. Additionally, data were evaluated for correlation with selected variables. The RI for serum gastrin following a 12-h fasting period was 15.1-78.9 ng/L with 90% confidence intervals for the lower and upper limits of 14.0-22.9 and 68.3-83.0 ng/L, respectively. A generalized linear model did not detect significant relationships between gastrin and age (P = 0.48), sex (P = 0.30), weight (P = 0.93), or total calcium concentration (P = 0.84). A 12-h fasted serum gastrin concentration RI has been established. Given the limited range of serum calcium concentrations in our healthy study population, additional investigations are needed to determine the effects of hypercalcemia on serum gastrin concentrations in dogs and for any potential clinical consequences thereof.

Preferences of clinical pathologists for probability-modifying terms describing cytologic sample evaluations: A survey study.

A recent study identified 7 probability ranges used by clinical pathologists and associated qualitative terms used in cytology reports. Clinicians and clinical pathologists agreed that limiting the number of terms could help enhance communication between clinical pathologists and clinicians. However, the preferred terms for each range remain undetermined. We sought to determine a single term for each probability range that could be adopted by the global veterinary clinical pathology community. Clinical pathologists responded to a survey invitation distributed via the specialty listserv. Clinical pathologists were asked to rank previously identified terms for each probability range from "most preferred" to "least preferred." An alternative term could be proposed if they preferred a term not included in the question. The preferences were summed by rank. Where first choice ranks were within 20% of each other, the 1st and 2nd choices were added. The term with the highest counts was chosen to represent the probability range. The highest-ranking terms corresponding to the probability ranges of 0%-20%, 20%-50%, 50%-65%, 65%-75%, 75%-85%, 85%-95%, and 95%-100% were "no evidence for," "cannot rule out," "possible," "suspicious for," "most likely," "most consistent with," and no modifier, respectively. We have sampled clinical pathologists across the globe to rank terms in cytology reports associated with previously identified probability ranges to identify single qualitative terms for which there was the most agreement between clinicians and clinical pathologists. Our study provides the foundation for standardizing and limiting probability-modifying terms to improve communication with clinicians.

Establishment of a feline glycated hemoglobin reference interval for a novel dried-blood-spot assay and the effects of anemia on assay results.

Glycated hemoglobin A1c (HbA1c) reflects long-term (months) glycemic control and has been previously investigated as a monitoring and diagnostic tool in diabetic cats. However, a standardized, reliable, and globally available test and reference intervals (RIs)have not been established. A novel dried-blood-spot card system (A1Care, Baycom Diagnostics) allows for easy collection and evaluation of HbA1c levels in feline patients. We aimed to establish an RI for HbA1c values in healthy adult cats using the A1Care (Baycom Diagnostics) dried-blood-spot card system. Forty-one healthy client-owned adult cats were enrolled in this study. The RI for HbA1c was calculated according to the recommendation of the American Society for Veterinary Clinical Pathology. The A1Care HbA1c RI for cats was determined to be 1.9%-3.1%. In healthy cats, A1Care HbA1c values were positively correlated with age (Spearman rho = 0.4 [95% CI 0.1 to 0.6], P = 0.01). In 50% of anemic cats, the A1Care HbA1c value was above 3.1%. There was a weak negative correlation between the A1Care HbA1c value and PCV (Spearman rho = -0.4 [95% CI -0.6 to -0.1]). This study established an RI for HbA1c in healthy adult cats similar to previously reported RIs. Future clinical studies are necessary to substantiate that this RI can differentiate diabetic from nondiabetic cats. Further long-term clinical studies will be valuable to determine if HbA1c values can be used as a screening test for prediabetes in cats.

Serum biochemical reference interval determination inwild Siberian weasel (Mustela sibirica).

Determining reference intervals (RI) isavaluable asset for assessing the health ofwildlife species. This isthe first study toestablish serum biochemical RIs inSiberian weasels. Forty-two healthy free-ranging Siberian weasels were captured live and brought toSeoul Wildlife Center between June 2021 and August 2022. Blood samples from 42healthy Siberian weasels ofboth sexes were used tocalculate RIs. Anautomated analyser was used toperform serum biochemistry profiles. The American Society for Veterinary Clinical Pathology recommendations were used tocalculate anonparametric RI with 90% confidence intervals. The RIs ofalbumin, total protein, globulin, calcium, glucose, blood urea nitrogen, phosphorus, amylase, cholesterol, alanine aminotransferase, total bilirubin, alkaline phosphatase, creatinine, and creatine kinase were determined. The RIs established inthis study will serve asagood starting point for analysing serum biochemical data inSiberian weasels.

Indexing hematological and serum biochemical reference intervals of Himalayan snow trout, Schizothorax esocinus to instrument in health assessment.

Schizothorax esocinus, commonly known as snow trout, is one of the main contributors of food and livelihood in the colder zone of Himalayan region. The comprehensive information on its hematological and serum biochemical reference intervals is not reported yet. In the present study an attempt has been made to elucidate the hematological and serum biochemical reference intervals of S. esocinus from River Jhelum using protocols of the American Society of Veterinary Clinical Pathology (ASVCP). Wild fish were sampled over a period of 2years from the pollution free sites of river Jhelum. Fish blood was harvested through caudal venipuncture and hemato-biochemical analysis performed thereof. Data values from a total of healthy 432 adult fish specimens (216 male, 216 female) were systematically recorded. The reference intervals for hematological and serum biochemical parameters of S. esocinus were established using Reference Value Advisor software v 2.1. RIs for hematological and serum analytes ranged as: hemoglobin (Hb) 78.38-116.35 (g/L); white blood cells (WBC) 10-20 (×109/L); red blood cells (RBC) 1.30-2.15 (×1012/L); packed cell volume 27.00-39.45 (%); total protein 39.21-61.62 (g/L); albumin 8.20-22.02 (g/L); globulin 27.58-49.55 (g/L); glucose 3.25-7.18 (mmol/L); urea 0.96-2.38 (mmol/L); cholesterol 3.80-6.90 (mmol/L). The study also depicted that certain blood measurands were influenced with respect to sex. Significantly (p < 0.05) higher values of Hb, red blood cells count and serum glucose were noted in male as compared to female which, on the other hand, registered higher white blood cells count and serum cholesterol level (Mann Whitney U test, p < 0.05). The work, therefore, provides baseline information on hematological and serum biochemical analytes of this species which holds high commercial importance. RIs reported here can help monitor the health status of fish by improving the use of non-lethal diagnostic methods in piscine medicine.

Dataset of Partial Analytical Validation of the 1,2-O-Dilauryl-Rac-Glycero-3-Glutaric Acid-(6′-Methylresorufin) Ester (DGGR) Lipase Assay in Equine Plasma

Laboratory assays require analytical validation to prove they are providing accurate results. This dataset describes the partial analytical validation of lipase activity, measured with the 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6′-methylresorufin) ester (DGGR) lipase assay in equine plasma. Samples with low (approx. 12 U/L), moderately increased (approx. 79 U/L), and markedly increased lipase activity (approx. 298 U/L) were chosen. Linearity was assessed in samples of ascending dilution prepared by mixing samples with low and high lipase activity in different proportions. Repeatability or intra-assay replication was evaluated by measuring each level in 25 replicates within the same run. Reproducibility or inter-assay replication was calculated by measuring each level in five replicates on five consecutive days. The assay was linear in the range of 12–298 U/L (R2 = 0.9998) with a &lt;2.3% deviation from the calculated value at any point. Within-run coefficients of variation were 4.43%, 0.69%, and 1.00% for the low, medium, and high samples, respectively. Between-run coefficients of variation were 3.57%, 1.42%, and 1.16%, respectively. To our knowledge, these are the first published data on the analytical validation of the DGGR lipase assay in horses, which may be of interest to veterinary clinical pathologists and equine clinicians measuring DGGR lipase in equine blood for diagnostic and research purposes.

European Society of Veterinary Clinical Pathology (ESVCP)/ European College of Veterinary Clinical Pathology (ECVCP) 19th Annual Meeting, Imperial College, London, United Kingdom-September 7-9th, 2017.

Veterinary Clinical PathologyVolume 52, Issue 1 p. 172-196 ABSTRACT European Society of Veterinary Clinical Pathology (ESVCP)/ European College of Veterinary Clinical Pathology (ECVCP) 19th Annual Meeting, Imperial College, London, United Kingdom—September 7–9th, 2017 First published: 13 February 2023 https://doi.org/10.1111/vcp.13239Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume52, Issue1March 2023Pages 172-196 RelatedInformation

Clinical pathologists should limit modifier terms used to denote probability of a diagnosis: a survey-based study.

To examine the probability estimates for modifying terms used by clinical pathologists when interpreting cytologic samples and compare these to probability estimates assigned to these terms by clinicians, and to provide restricted, standardizing terms used in cytology reports. 49 clinical pathologists and 466 Veterinary Information Network members responded to 2 similar surveys. Online surveys were distributed to diplomates of the European College of Veterinary Clinical Pathologists and clinician members of the Veterinary Information Network, made available between March 17, 2022, through May 5, 2022. Respondents assigned a range of probabilities to each of 18 modifier terms used by clinical pathologists to denote probability associated with diagnoses; clinicians identified terms that would affect their treatment decisions in cases of canine lymphoma. Respondents then provided thoughts about restricting and standardizing modifying terms and assigning numeric estimates in reports. 49 clinical pathologists and 466 clinicians provided responses. For many terms, probability ranges agreed between the 2 groups. However, differences in estimated probability inferred by a term existed for at least 6 terms. Modifying terms could be restricted to 7 largely nonoverlapping terms that spanned the range of probabilities. Clinicians preferred having numeric estimates of probability, but clinical pathologists resisted providing such estimates in reports. Reducing and standardizing the number of modifying terms to reflect specific probability ranges would reduce disagreement between the clinical pathologist's intended probability range and the clinician's interpretation of a modifying term. This could result in fewer errors in interpretation and better patient care.

Acute phase proteins in cats: Diagnostic and prognostic role, future directions, and analytical challenges.

While clinical studies on acute phase proteins (APPs) have significantly increased in the last decade, and most commercial labs are now offering major APPs in their biochemical profiles, APP testing has not been widely adopted by veterinary clinical pathologists and veterinarians. Measurement of APP concentration is a useful marker for detecting the presence or absence of inflammation in cats with various diseases. APPs can also be reliably measured in different biological fluids (eg, effusions and urine) to improve their diagnostic utility. Measurement of APPs can be extremely beneficial in cats with feline infectious peritonitis (FIP) to discriminate between FIP and non-FIP cats with similar clinical presentations. Additional benefits come from multiple and sequential measurements of APPs, particularly in the assessment of therapeutic efficacy. APPs are more sensitive than WBC counts for early detection of inflammation and to demonstrate an early remission or recurrence of the diseases. Given the potential utility of APPs, more studies are warranted, with a particular focus on the applications of APPs to guide the length of antimicrobial therapies, as suggested by the antimicrobial stewardship policy. New inflammatory markers have been discovered in human medicine, with a higher specificity for distinguishing between septic versus nonseptic inflammatory diseases. It is desirable that these new markers be investigated in veterinary medicine, to further test the power of APPs in diagnostic setting.